Dear Doctor,

My 24-year-old daughter is in her 12th week of pregnancy but she said she noticed slight bleeding. She visited a doctor but was told that nothing was wrong and that it may happen sometimes. I’m not sure of this. Should we be worried?

Megan

Dear Megan,

Pregnancy occurs due to equilibrium of the hormones, human chorionic gonadotropin and progesterone. Normally, stopping of menstrual cycles is the first indication of pregnancy which prompts one to undergo tests to confirm pregnancy. However about 12 per cent of women continue to have slight vaginal bleeding like menstruation, which continues till the 12th week and then stops. It can be due to the time taken for establishing the equilibrium of hormones necessary for causing and maintaining pregnancy. It can also be due to the delay in attachment of the fertilised ovum to the uterine wall.

But if vaginal bleeding occurs after complete cessation of menses during pregnancy, it could be due to some underlying problem.

Threatened abortion is the first such condition, which causes vaginal bleeding in the first 20 weeks of pregnancy. If not checked, it can cause a complete miscarriage. Threatened abortion can occur due to some infection bacterial or viral during early pregnancy. It can be due to obesity, uncontrolled diabetes, trauma to the abdomen, abnormal pregnancy and non-viable foetus, that is, vesicular mole. Increased maternal age (35 years and above) is yet another risk factor for threatened abortion. One who has suffered a threatened abortion or miscarriage in a previous pregnancy is at greater risk of threatened abortion again in subsequent pregnancy. Apart from vaginal bleeding, one experiences backache, abdominal cramps in threatened abortion. Treatment consists of bed rest and managing the underlying cause. Heavy continuous bleeding occurs due to a complete abortion. This condition necessitates complete evacuation of the uterus. Sometimes, the growing foetus may die within the uterus, causing vaginal bleeding

Slight vaginal bleeding can occur during early pregnancy due to vaginal trauma caused by sexual intercourse. An abnormally located placenta may start tearing off as pregnancy continues, causing slight bleeding in the first trimester. Bleeding any time during the first 12 weeks of pregnancy could be due to ectopic pregnancy. In this, the fertilised ovum gets implanted at some other site, in place of inner lining of uterus. The most common site is the fallopian tubes. It can be a life threatening condition.

Dr Rachna is a specialist in internal medicine rachna212002@yahoo.co.uk