Early Pregnancy Bleeding and Threatened Miscarriage

Why Your Doctor Might Say Your Symptoms Mean a Threatened Miscarriage

Worry Often Accompanies Miscarriage Symptoms
When you have a threatened miscarriage, waiting for test results can be very difficult emotionally when you are having miscarriage symptoms.. Photo: Marili Forastieri / Getty Images

Being told you have a threatened miscarriage is like having your entire future placed in limbo. A woman might be having miscarriage symptoms and head to her doctor, but then the doctor isn't able to immediately answer whether or not her symptoms are the signs of a miscarriage. For example, a woman might have light vaginal bleeding in early pregnancy but have a closed cervix (a dilated cervix would be a sign that the miscarriage was in progress).

What Happens in a Threatened Miscarriage

In cases of threatened miscarriage, a doctor might order diagnostic tests to judge the viability of the pregnancy, such as ultrasound and hCG blood tests. But getting useful information from the results takes time. In early pregnancy, a woman would need at least two hCG blood tests spaced two days apart to judge whether the levels are rising or falling. Similarly, ultrasound often needs to be repeated a few days or a week later in order to conclusively diagnose an early miscarriage.

A similar situation arises for women who do not have miscarriage symptoms but who have an early ultrasound and see no heartbeat. In these cases, there is a chance that the pregnancy could be viable but the dating inaccurate -- or it could be a missed miscarriage. The doctor might order a followup ultrasound in a week.

In either case, the wait for answers can be painful. Women are left not knowing whether they need to be planning for a baby or grieving the loss of one.

The limbo can last for days. It can be impossible to think of anything or go about daily life until there they have an answer one way or the other.

If you are having miscarriage symptoms and need to wait for repeat hCG levels or another ultrasound, here are some things to keep in mind:

  • It's normal to be frustrated and angry over the situation, but try not to direct your anger at your doctor. In early pregnancy, there is nothing your doctor can do to change the outcome. And if you're forced to wait for test results, the reason for the wait is that your doctor wants to be totally sure before diagnosing a miscarriage -- rather than taking the chance of possibly offering a D&C to someone with a viable pregnancy.

  • Some doctors suggest bed rest and avoiding sexual intercourse for women with threatened miscarriage. There is no conclusive evidence that this practice changes the outcome for the majority of women with threatened miscarriage, but because advice may vary based on individual situations, you should follow your doctor's advice one way or the other.

  • Some doctors may suggest unproven medications, such as progesterone supplements, for women who have threatened miscarriages. Usually this is with the idea that these treatments cannot hurt and might help. No medication has been proven to change the outcome for women with threatened miscarriage in the first trimester. If your doctor is suggesting a specific treatment, it probably won't hurt anything to try it.

  • Don't overthink the situation. It's normal to spend hours searching the Internet seeking out stories of good outcomes to threatened miscarriage. While it's good to keep in mind that your outcome might be positive, thinking about it too much can build false hope and set you up for greater disappointment if the news goes the other way.

  • Hard as it is, try to take your mind off things somehow. Work may be unavoidable. But when you're home, rent a pile of movies. Or pick up a good novel you've been wanting to read. If you have other kids, see if a friend or relative can watch them for a few days until you receive word on what's going on.

    Ultimately, you may receive reassuring news. The bleeding might stop and your repeat hCG level might show that your numbers are doubling. An ultrasound might show evidence of a normal, viable pregnancy, and all of this will be a bad memory.

    If the ultimate outcome is not good news, remember that it's not your fault and that it's normal to grieve. Call on supportive friends if you need to talk, or try a support group. Take your time and don't push yourself too hard as you begin to cope with the loss.

    Sources:

    Aleman, A., F. Althabe, J. Belizan, and E. Bergel, "Bed rest during pregnancy for preventing miscarriage." Cochrane Database of Systemic Reviews 2005. Accessed 28 Mar 2008.

    Sotiriadis, Alexandros, Stefania Papatheodorou, and George Makrydimas, "Threatened miscarriage: evaluation and management." BMJ July 2004. Accessed 28 Mar 2008.

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