Dear Doctor,

After all the classic symptoms of pregnancy, I took a test and it came out positive. I’m 24 years old and this is my first. I’m not sure how far along I am though. However, for about three days now, I’ve had what I assume is a period. Is that possible? Can I still get my period even when pregnant. I’ve heard people talk about spotting during pregnancy, should I be worried?

Anne

Dear Anne,

How many days after the confirmation of pregnancy did the bleeding start? What is the quantity of blood passed, is it just a drop or so or more? Usually pregnancy is first suspected and diagnosed when a woman stops having her menstrual period. However, about 25 per cent of women or more can experience some very minor bleeding (spotting) in the first 4 weeks of pregnancy. This can be due to the hormonal changes occurring in pregnancy. It can be due to sexual intercourse. Minor tears in the vagina or cervix can occur during a vaginal examination, or sexual intercourse can cause this spotting. It can occur in the process of implantation, where immediately after fertilisation the fertilised egg implants itself to the inner side of uterine wall.  There is nothing to worry about this spotting, as it resolves by itself with time. Acute infections of the vagina or cervix in early pregnancy can also cause spotting.

However, there are other sinister causes of vaginal bleeding in the first trimester. A miscarriage or abortion is the most common one.  Abortion in early pregnancy can be due to chromosomal abnormalities in the foetus. It can be due to trauma to the lower abdominal wall, hormonal imbalance, acute pelvic infections or exposure to environmental and industrial toxins. Due to cervical incompetence (or cervical insufficiency) –where the opening of the lower end of uterus is loose - termination can occur as the uterus is unable to hold the pregnancy. In many cases of early abortion, no identifiable cause can be found. Along with vaginal bleeding, one experiences lower abdominal pain and muscular cramps in the legs due to the abortion. What started as spotting can progress to severe bleeding, needing urgent treatment.

Abnormal situation of the placenta (placenta praevia), is yet another cause of vaginal bleeding in pregnancy. Ectopic pregnancy, where the foetus is implanted outside the uterine wall (most commonly in a fallopian tube) causes bleeding, which may be mild initially and is accompanied by severe abdominal pain. It is an emergency and needs urgent intervention to save the life of the mother. Rarely, a non-viable foetus is implanted and continues to grow (molar pregnancy). This can cause vaginal bleeding though one may test positive for pregnancy. At times it may be the adverse effect of some anti-clotting drug being taken, like aspirin.

If spotting has been noticed in pregnancy, it is advisable to consult qualified medical personnel to exclude a serious and manageable cause. If there is indeed an underlying problem, it can be diagnosed and treated at the earliest stage and if possible, the baby can be saved. The underlying cause for bleeding and viability of the foetus can be determined by clinical examination and pelvic ultrasound.                                        

 Dr.Rachna  Pande is a specialist in internal medicine.