In addition to the various early pregnancy reactions, vaginal bleeding sometimes occurs during early pregnancy, usually as a sign of embryonic damage. About half of the patients will have a miscarriage or ectopic pregnancy and half will continue the pregnancy until delivery. Therefore, it is important not to take vaginal bleeding lightly.
Early pregnancy (early pregnancy) refers to the period before the end of the 12th week of pregnancy, during which the embryo develops rapidly. In addition to various early pregnancy reactions such as nausea, vomiting, breast tenderness, frequent urination, and mild abdominal pain, vaginal bleeding may also occur during early pregnancy, ranging from brown blood, pink discharge, or red blood on your underwear to menstrual bleeding. Vaginal bleeding may or may not be accompanied by pain in the abdomen. Usually bleeding during early pregnancy is a sign of embryonic damage. About half of the patients who bleed during early pregnancy will have a miscarriage or ectopic pregnancy, and half will continue the pregnancy until delivery.
Causes of bleeding during early pregnancy
1. bleeding during early pregnancy may be caused by the presence of small blood vessels of the uterine meconium injured during the implantation of the embryo, which can be saved.
2. it may be an early manifestation of ectopic pregnancy, which should be diagnosed and treated early.
3. it may also be a pre-eclampsia, refractory miscarriage, or embryonic abortion. refractory miscarriage can be diagnosed quickly by speculum examination, while pre-eclampsia and ectopic pregnancy may require a period of observation before a decision can be made.
In order to protect the pregnant woman and the fetus as much as possible, clinicians should identify the cause of bleeding as early as possible and deal with it promptly.
Identifying the cause of bleeding during early pregnancy
Bleeding during early pregnancy is not easy to identify if it occurs shortly after conception, such as within 2 weeks of fertilization. The blood chorionic gonadotropin (HCG) and progesterone are not high during this period, and when the blood HCG is lower than 1500-2000 IU, the embryo will not be visible on ultrasound, so only observation can be made at this time. In case of implantation bleeding, it is often self-limiting and will stop on its own after some time.
After 3 weeks of fertilization, it is the period of rapid development of the embryo after implantation. Bleeding in this period can be diagnosed by the following methods.
1. Opening the speculum for examination can reveal bleeding due to cervical causes, which can diagnose refractory abortion.
2. The cause of bleeding can be found by testing three indicators: blood HCG, blood progesterone value and ultrasound.
When the blood HCG rises above 1500 IU, vaginal ultrasound can be used to find the fetal sac. When the blood HCG rises above 2000 IU, the fetal sac can be found by abdominal ultrasound. If the fetal sac is found outside the uterus or inside the uterus, the presence of ectopic pregnancy can be determined. It can be said that an ectopic sac seen on ultrasound is the gold standard for the diagnosis of ectopic pregnancy. If the sac is located in the uterus, ultrasound can also determine the location of the embryo implantation, for example, is it an angular pregnancy (which is often indicative of uterine adhesions or uterine malformations)? Is it a cesarean scar pregnancy? Is there intrauterine bleeding outside the gestational sac? Does the embryonic development correspond to the date of menopause, etc. All these conditions can help to clarify the cause of bleeding during early pregnancy.
For bleeding after 3-4 weeks of fertilization, in addition to ultrasound to find the cause, the changes in blood HCG and progesterone must be monitored dynamically. Usually after 3 weeks of fertilization (i.e. more than 5 weeks from the first day of the last menstrual period), the blood HCG doubles significantly and the progesterone will be above 25ng/ml. Observing the dynamic changes in blood indicators at this time helps to understand the cause of early pregnancy bleeding. The so-called dynamic changes should be rechecked in about 2-3 days. Normally the blood HCG should increase at least 1.66 times every 48 hours and should double every 72 hours, if it does not reach this rate, it indicates slow intrauterine development of the embryo or ectopic pregnancy. If the HCG drops rapidly in an exponential manner after vaginal bleeding, it mostly indicates that the embryo has been shed or has died.
Progesterone is also a good indicator to monitor embryonic development: after 5-6 weeks of early pregnancy (counting from the first day of the last menstrual period), progesterone should reach 25ng/ml (25X3.18=79nmol/L) or more. 20ng/ml is a slightly lower level and this level can be reversed if the adverse factors are corrected at this time. Progesterone below 15ng/ml is an indicator of danger, when the trend of embryonic dysplasia is mostly irreversible. If the progesterone is below 10ng/ml, it is almost impossible to save the embryo. It is also important to note that low progesterone is sometimes the cause of embryonic dysplasia, but more often it is the result of embryonic dysplasia.
If there is a drop or disappearance of HCG before the location of the embryo is detected by ultrasound, it is usually a biochemical pregnancy as the saying goes. Those with a biochemical pregnancy can no longer identify an ectopic or an intrauterine pregnancy.
In early pregnancy there are deeper causes such as high blood pressure, abnormal glucose metabolism, abnormal thyroid function, abnormal coagulation mechanisms, infections, immunological factors, in addition to implantation bleeding, preterm and inevitable miscarriage, and ectopic pregnancy. Where possible, these indicators should be tested to perhaps detect the cause of abnormal embryonic development, such as high blood sugar, high blood pressure, hypothyroidism, etc. It is also beneficial to make purposeful adjustments before the next pregnancy.
Respond carefully
For patients who bleed during early pregnancy, they should be advised to.
1. to reduce their activities (it does not mean that they must always be bedridden to come).
2.Watch carefully what falls out, and keep any flesh-like tissue for the doctor to see.
3.When there is obvious abdominal pain, or bleeding more like menstrual volume, or dizziness, go to the emergency room in time to avoid delaying the resuscitation of internal bleeding of ectopic pregnancy. If you do not have the above symptoms (abdominal pain, heavy bleeding, dizziness, etc.). Blood tests for progesterone, blood HCG and ultrasound should be done regularly, usually at least once every 3 days.
If the blood HCG drops rapidly during regular blood tests for progesterone and blood HCG, the embryo may have been shed and the blood HCG should be checked weekly until it is tracked to a normal level.
Rising HCG If the blood HCG rises slowly, monitor closely and check progesterone, blood HCG or ultrasound every 3 days or so. If an ectopic pregnancy is detected during this period, treat it quickly. If intrauterine pregnancy has been confirmed, observe the development of the embryo in the uterus. If there is bleeding in the uterine cavity outside the fetal sac, the volume of bleeding is not large and can be observed with the possibility of absorption. If the blood progesterone is below 15ng/ml, the embryo is more dangerous. If the blood HCG continues to rise slowly with less than 20% rise in 3-day interval, it also indicates that the embryo is underdeveloped. When various indicators are combined to determine that the embryo has stopped developing, embryonic abortion should be cleared as early as possible.
Medication
Progesterone: If progesterone rises slowly, progesterone can be applied to preserve the fetus. Progesterone can make the endometrium more suitable for embryo development and can inhibit uterine contraction to play the role of fetus. Progesterone can be administered orally, intramuscularly, or intravaginally. Progesterone can be administered orally by 2 tablets of 10mg each in the morning and 2 tablets in the evening; progesterone pills of 100mg each in the morning and 2 pills in the evening; progesterone injection of 40mg once a day by intramuscular injection; progesterone extended-release gel of one tablet per day by vaginal application. Progesterone dose should be adjusted by intermittent progesterone check during the medication.
Some people worry about progesterone causing embryonic malformation, which is not based on facts. Progesterone, as currently applied, is a natural ingredient and is no different from endogenous progesterone. Progesterone is the classical method of fetal preservation and its safety and effectiveness have been proven by its long-term and widespread use. Some people ask if progesterone is used for ectopic pregnancy, won’t it be a problem? In fact, there is no trouble. The use of progesterone for ectopic pregnancy does not delay the diagnosis of ectopic pregnancy, nor does it increase the trouble of handling it.
2. Chinese medicine: there are ready-made medicines and tonics, which should be prescribed by Chinese medicine practitioners after identification.
3.Other: For bleeding caused by abnormal embryonic development due to hypertension, hyperglycemia and abnormal nail function, it should be corrected as much as possible, and it is better to mend than not to mend.
Finally, I would like to repeat that 50% of the cases of bleeding in early pregnancy can be turned around, so don’t be too nervous. The best attitude is to take things as they come and let nature take its course.