Mild cramping and light spotting are normal early in pregnancy when the fertilized egg implants itself in the uterus. But vaginal bleeding could be a sign of something more serious.

What should I do if I am bleeding?

Call your doctor right away. If you have heavy bleeding or severe pain, go to the emergency room.

What causes bleeding during early pregnancy?

Mild cramping and light spotting are normal early in pregnancy when the fertilized egg implants itself in the uterus. But vaginal bleeding could be a sign of something more serious. Some of the most common causes are:

Threatened miscarriage (also called threatened abortion). When a threatened miscarriage occurs, there is bleeding from the uterus (also called the womb) but the pregnancy is still normal. Sometimes a blood clot forms in the uterus and increases the risk of miscarriage. However, most women who have a threatened miscarriage will deliver a healthy baby.

Ectopic pregnancy. An ectopic (say: “eck-tah-pick”) pregnancy occurs when the fetus grows outside the uterus, usually in the fallopian tubes. The fallopian tubes are tubes that carry the egg from the ovaries to the uterus. An ectopic pregnancy can also occur on one of the ovaries, on the cervix (the opening of the uterus) or in the abdomen. Signs of an ectopic pregnancy include heavy bleeding, sharp abdominal pain and cramps. Ectopic pregnancies are life-threatening.

Spontaneous abortion (also called miscarriage). A spontaneous abortion is the spontaneous loss of a fetus. Most miscarriages occur because the fetus is not developing normally. Uncontrolled diabetes, infection, thyroid disease and hormonal problems in the mother can also cause spontaneous abortion. Other signs of a miscarriage may include sharp or dull low back or abdominal pain, cramps and tissue passing through the vagina.

Other causes of early pregnancy bleeding include infections, swollen veins in your rectum or anus called hemorrhoids (say: “hem-roids”), cervical cancer and rare pregnancy-related cancers.

How will my doctor diagnose the cause of my bleeding?

Your doctor will probably want to know how much and how long you have been bleeding. He or she will also ask you if you have any cramps or pain. You may need a pelvic exam, an ultrasound, blood tests or urine tests. Sometimes an ultrasound is enough to make sure your pregnancy is healthy. However, if you are very early in your pregnancy, you may need more tests to help your doctor find the cause of the bleeding.

Will I need treatment?

You may need treatment depending on the cause of the bleeding. There is no way to stop a threatened miscarriage with medicines after the bleeding starts. Your doctor will likely recommend that you rest as much as possible until the bleeding stops. You should also avoid traveling, exercise and sexual activity.

If you have a miscarriage, your doctor will watch to see if the tissue passes on its own, or if you will need a procedure to help remove it. In some cases, the mother may need to have a procedure done to remove tissue or to stop the bleeding after a miscarriage. This procedure is called suction dilation and curettage (D and C). A doctor will open (dilate) the cervix and gently suction out the tissue from the miscarriage.

What can I do to prevent a miscarriage?

Keeping your body healthy is the best way to have a healthy pregnancy and baby. Do not smoke cigarettes, drink alcohol or take illegal drugs. Talk to your doctor before taking over-the-counter or prescription drugs. Take a prenatal vitamin with folic acid before you get pregnant to lower the risk of brain and spinal cord problems in your baby. If you have medical problems, such as high blood pressure or diabetes, talk with your doctor about the care you will need during your pregnancy before you get pregnant.

There is no way to prevent a miscarriage after bleeding has started. There is also no way of knowing exactly why a miscarriage happens. Usually, it is not because the mother did anything wrong. Most women who have had a miscarriage can have healthy pregnancies in the future. If you have lost more than 3 pregnancies, talk to your doctor about other tests and treatments.

• What is the likely cause of my bleeding?
• What tests to I need to help diagnose the cause?
• Is my baby at risk?
• Is my life at risk?
• What are my treatment options? What treatment do you recommend for me?
• I had a miscarriage. Will I need any follow-up care?
• How does a miscarriage affect my chances of having another baby in the future?
• I feel guilty. Could I have caused the miscarriage?
• I feel sad. Is there someone I could talk to about my feelings? A support group?