Patient Information: Our Lady Of Lourdes Hospital, Drogheda

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Are bleeding and pain common in early pregnancy?
Yes.
Even though it can be very worrying, around 1 in every 3 women will experience bleeding or pain in the first few weeks of pregnancy.

 

What do bleeding and pain mean for my pregnancy?
Any time that you experience bleeding or crampy abdominal pain in a pregnancy we have to consider the possibility of a miscarriage, or a pregnancy in the wrong place. However, because these symptoms are so common, this is not always the case. Time is often the only sure way to answer this question. If the bleeding and pain resolve, and we have been able to see a heartbeat on an ultrasound scan that is a very strong indicator that the pregnancy will continue. If unfortunately the bleeding and pain are getting worse over time, this may mean that the news is not what we are hoping for.

 

What can I expect during my visit to the Early Pregnancy Unit?
When you arrive in the EPAU a secretary will check you in and take down all of your details. This is so that you have a file created for this pregnancy, one that we can use to digitally store any test results and images during your time with us in the clinic. This helps make sure we have accurate information throughout the course of your pregnancy.

It's important that you arrive promptly for your appointment so that we can offer every woman who has concerns enough time during a clinic session. It is also ideal for you to try to have a full bladder, as this helps us perform an ultrasound scan through your tummy.

When you are in the clinic you will notice a few people in the room. The doctor, a specialist midwife and sometimes an ultrasonographer (a person trained in ultrasound scans only).There may sometimes be a nursing or medical student present as well, but you may ask them to leave if you feel uncomfortable. Your partner, family member, or a friend is welcome to stay with you during your visit.

In the clinic your history will be taken once more and an ultrasound scan will be performed. Sometimes if your bladder is empty, or the pregnancy is in its very early stages, a scan through the tummy is too far away to see clearly and we may offer you an internal ultrasound scan. Occaisionally if we are still not getting a clear picture, we might suggest a series of blood tests as well.

You can expect a clear understanding of what we have found. If we feel we do not have enough information or it is too early to make a diagnosis we will arrange for follow up with the EPAU. You will be given information about what symptoms to look out for, when to attend the hospital and a card with your appointment and our contact number in case you have any follow up questions.

 

What are the possible findings on ultrasound?
Ultrasound images can be affected by a variety of factors, including:
- how far along in the pregnancy you are,
- your weight,
- whether you have a full bladder,
- whether you have anatomical differences in your womb such as fibroids, or a womb of a different shape or angle ('retro-verted')

An ultrasound image may not always provide us with a diagnosis. More often than not in the very early stages of pregnancy when no baby can be seen, we use ultrasound along with your history and sometimes blood tests, to suggest what may be happening.

If the findings are not clear from an ultrasound scan a follow up appointment will be made for you in 2 weeks time to see how your pregnancy has developed.

 

Early scans (before 6 weeks)
In the very early stages of pregnancy your baby is incredibly small, often a few millimeters in size. If you attend the EPAU before 9 weeks your doctor or sonographer may be able to point out an area on the scan that will grow to become your baby.

scan before 6 weeks

If you are beyond 6 weeks, a fluttering should be visible that represents the heart beat.


Later scans (after 10 weeks)
These are the sorts of ultrasound pictures that everyone expects when they go for a scan.

scan after 10 weeks

However, a scan will only look like this after 12 weeks, once your baby has grown in size.

Remember that even though you may be sure of when your baby was conceived, many variables are involved such as the timing of your ovulation, fertilization and implantation of the embryo (which can be affected by the length of your menstrual cycle), whether or not you have been using oral contraceptives and even stress. Your scan may differ from how far along you expected to be.

 

Why have I been called back with the results of my blood test?
If we have concerns about your pregnancy being outside of your woman (ectopic) we may suggest that you have two blood tests. These tests measure the level of pregnancy hormone in your blood. This can be helpful in a number of ways. If the hormone value is very low, we can be reassured that it is probably too early in your pregnancy (less than 6 weeks) to have seen anything on ultrasound scan.

We then look at the change in hormone level between the first and second blood tests. In a healthy ongoing pregnancy, we would expect the hormone levels to double every two days. If the pregnancy is not continuing, we would see the hormone levels dropping.

You may receive a telephone call from the doctor on duty in the Gynaecology Ward after having a blood test taken. When this happens it is usually because we have reviewed your hormone levels and are concerned that they may suggest your pregnancy is not in the womb. In these cases, you may be asked to come in to the hospital to be admitted and monitored for a few more days to ensure your safety.

Further information is available on

www.miscarriage.ie

www.miscarriageassociation.org.uk

www.mayoclinic.com/health/pregnancy

This information is based on local (HSE/OLOL Drogheda), National (RCPI), and international (RCOG) early pregnancy guidelines.

 

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