Threatened miscarriage - Newcastle Hospitals NHS Foundation Trust

About 20 per cent of pregnant women will experience bleeding in early pregnancy. Although women are often very worried about this, it is not always the sign of a serious problem.

However, with bleeding there is a higher chance of miscarriage. About one in three women with bleeding will go on to miscarry.

What are the signs of threatened miscarriage?

Vaginal bleeding which may be fresh red blood, brown discharge or spotting
Pain in the lower abdomen, often described as cramp-like pain or backache.

What should I do if I have bleeding in pregnancy?

If you have any bleeding and/or pain, you can get medical help and advice from:

Your GP or midwife the early pregnancy assessment unit (EPAC).
NHS 111 is available 24 hours a day, and calls are free from landlines and from mobile phones
Your local A&E department particularly if you are bleeding heavily, have severe pain or feel very unwell.

If it is not an immediate emergency, we will take some information and arrange an assessment. This will likely involve a scan, and possibly an examination or some blood tests.

If your bleeding is not heavy, then they might suggest that you rest at home for a soon appointment over the next 48 hours.

What investigations are needed for a threatened miscarriage?

A transvaginal ultrasound scan will often be performed to check the pregnancy. This involves inserting a small probe inside your vagina. Your privacy and dignity is maintained at all times.

The scan is safe and will not cause additional risk to the pregnancy. You can bring someone with you for support.

Sometimes, especially in very early pregnancies, it is not possible to be sure if the pregnancy is healthy on the first scan and you will be asked to return for a repeat scan and possibly some blood tests. In this circumstance time is needed to see if a heartbeat develops normally.

This can be an anxious time but there is nothing that the nurses or doctors can do to speed this up. We will explain the scan findings to you (and your partner if present) and you will be given the opportunity to ask questions.

What causes a threatened miscarriage?

In most cases it is not possible to be sure about what caused the bleeding.

It is possible that it is caused by

A vaginal infection
Cervical bleeding – in pregnancy the cervix (neck of the womb) is more sensitive. Friction
through exercise or sex can cause bleeding
‘Implantation bleed’ – as the pregnancy attaches to the womb lining, causing some
bleeding
A small blood clot around the amniotic sac (subchorionic haematoma).

Treatment for a threatened miscarriage

We advise for you to rest if you have bleeding in early pregnancy. You should avoid strenuous exercise and avoid sex until the bleeding has settled.

We understand that this can be a stressful time, so if time off work is needed, please ask the hospital staff for a ‘fit note’ for your employer.

Progesterone treatment

Progesterone (drug name Cyclogest or Utrogestan) is taken as vaginal pessaries, 400mg twice daily from when you have a scan showing a normally sited pregnancy until 16 weeks of pregnancy.

The initial prescription will be given to you in the early pregnancy unit. Future prescriptions should be obtained from your GP. If you have any concerns or difficulties, please contact the Early Pregnancy Unit.

Treatment studies

Studies have shown that women, who are bleeding and have had more than one miscarriage
may benefit from taking progesterone.

PROMISE study

Promise study studied 836 women with unexplained recurrent miscarriages at 45 hospitals in the UK and the Netherlands and found a 3% higher live birth rate with progesterone.

PRISM studied

4,153 women with early pregnancy bleeding at 48 hospitals in the UK and found there was a 5% increase in the number of babies born to those who were given progesterone who had previously had one or more miscarriages, compared to those given a placebo.