Threatened Miscarriage

What is threatened miscarriage?

An ongoing pregnancy associated with vaginal bleeding, with or without abdominal pain, is known as a threatened miscarriage.

The diagnosis is usually made after examining the neck of your womb (cervix) and performing an ultrasound scan that confirms the presence of the baby’s heartbeat. This does not necessarily mean that the pregnancy will miscarry and most women go on to have a healthy pregnancy.

What are the causes of threatened miscarriage?

• Implantation bleeding – Bleeding from the process of the embryo embedding into the endometrium.
• Subchorionic haematoma – A collection of blood (blood clot) around the pregnancy sac. This may be seen on ultrasound scan.
• Hormonal imbalances – A low level of progesterone, a hormone which is essential to maintain the womb lining.
• Infections – Urine or vaginal infection may cause vaginal bleeding / spotting from the inflamed vaginal tissues

In many cases, we do not find a specific cause.

What can be done?

Hormonal supplementation

If you have had at least one previous miscarriage:

• Some studies suggest that vaginal or oral progesterone hormonal supplementation may reduce the risk of a miscarriage.

If you have had no previous miscarriage:

• There is no strong evidence to recommend hormonal supplementation to reduce the risk of miscarriage. However, you can choose to take vaginal or oral progesterone tablets if you wish to.

Blood test to measure progesterone level

• This may provide some guidance about how your pregnancy is progressing:
  
  • A higher level (above 35 nmol/L) is generally a positive sign and suggests that the pregnancy is more likely to continue normally
  • A lower level (below 35 nmol/L) may be associated with higher chance of miscarriage, but it does not always mean the pregnancy will not continue. Some pregnancies with lower progesterone levels still have a good outcome.
• Your doctor will consider this result together with your symptoms and scan findings to give you the best possible advice and care.

Other advice

Work
You are advised not to do strenuous work if the bleeding continues.

Bed Rest
There is no evidence that bed rest can prevent a miscarriage from occurring.  Bed rest is not routinely recommended as immobility leads to higher risks of blood clots in the legs (deep vein thrombosis). There may be at times increased bleeding when you get up to go to the toilet. This is because there may be pooling of blood in the vagina from lying down, which drains out upon standing.

Sexual Intercourse
Having sexual intercourse during pregnancy does not have any adverse outcomes. However, it is sensible to avoid sexual intercourse until the bleeding has completely stopped.

Emotional Support
Experiencing bleeding in pregnancy can be frightening and emotionally overwhelming for some women. It is completely normal to feel anxious, uncertain or upset during this time. Talk to your doctor or nurse about how you are feeling.

Sharing your thoughts with someone you trust, a partner, friend, or family member, can also help.

When to seek help?

Heavy vaginal bleeding

• Bright red bleeding suggests that it is fresh bleeding while brown blood suggests that it is old blood that is trickling down.
• If the bleeding becomes bright red or becomes heavier, seek medical attention.

Severe abdominal pain

Dizziness or fainting

Fever or foul-smelling vaginal discharge

Where do I seek help?

You can seek immediate medical attention at the Urgent O&G Centre, Basement 1, Women’s tower KKH at any time.

Alternatively, if your bleeding is not very heavy and/or have mild abdominal pains, you can call for a same day appointment at the Early Pregnancy Assessment Unit (EPAU):

Central appointments: 6294-4050
Alternative appointment line: 6394-1199

The information above is also available for download in pdf format.