Bleeding: Usually the first sign of early pregnancy loss is bleeding from the vagina. Vaginal bleeding may be light or heavy, constant or on and off. Pain/cramping: Usually in the lower belly or lower back. Passing tissue: In early pregnancy loss, dark red blood clots or thick stringy material may pass from the vagina. However, not all pain or bleeding ends with a pregnancy loss. Conversely, some people don’t have any symptoms at all when they experience a loss.

Early pregnancy loss—a miscarriage in the first 13 weeks—happens in about one in five pregnancies. If it happens, it is most likely to occur within the first trimester of pregnancy. The most common sign of a miscarriage is bleeding. But not all pain or bleeding ends with a miscarriage. In fact, roughly half of all pregnancies will have spotting at some point in the pregnancy.

There are many causes of vaginal bleeding during early pregnancy (first trimester). Roughly 50% of all pregnancies will have some amount of bleeding during this time. Sometimes bleeding is a sign of a miscarriage but often it is not. Bleeding should not be ignored and should always be reported and investigated with your health care providers. If you are experiencing vaginal bleeding or pain, you should seek medical attention. If the bleeding is mild, it may be appropriate to follow-up with your family physician, midwife, or obstetrician, on an urgent basis, at your provider's discretion. If none of these options are available to you in the next one to three days, you may need to go to your local emergency department. Common causes of bleeding in the first trimester can include: i. Implantation bleeding: this is usually light bleeding or spotting that can happen when the fertilized egg implants in the uterus. ii. Subchorionic hemorrhage (or hematoma): this occurs when blood collects under one of the membranes (chorion) surrounding the embryo in the uterus. This is generally not dangerous to your pregnancy and usually resolves on its own. iii. Cervical bleeding: The cervix may bleed more during pregnancy as blood vessels are developing in this area. It is possible to have cervical bleeding after sex, a pap test, or a pelvic exam. iiii. Cervical polyp: This is a usually benign growth on the cervix that can bleed. v. Infection: such as urinary tract infection (UTI), sexually transmitted infections (STIs), or yeast infections. vi. Ectopic pregnancy: An ectopic pregnancy happens when the embryo implants outside of the uterus. The most common location is inside one of the fallopian tubes. If it grows in the fallopian tube, it can cause the tube to burst (rupture). An embryo cannot grow normally outside of the uterus and so these pregnancies will not be successful. vii. Early pregnancy loss: also referred to as a miscarriage, is the loss of pregnancy during the first 13 weeks of pregnancy (first trimester).

Go to the nearest emergency department if you: Suddenly have severe pain in your abdomen that is not going away or helped with acetaminophen (Tylenol) Suddenly feel faint or like you are passing out Have very heavy bleeding (soaking more than three pads in three hours) Have chills or a fever higher than 38°C (100.4°F) These are what health care providers call ‘red flags’. These could be an indication that the pregnant person is in danger and should seek care in their nearest emergency department immediately.

The two tests that are most helpful in determining if a pregnancy is not developing as expected or if it has ended are: 1) an ultrasound (a medical scan); and 2) a blood test (B-hCG) The blood test for human chorionic gonadotropin (hCG) is a hormone made by the developing placenta. A low or decreasing level of hCG can mean loss of the pregnancy.

It is unpredictable how long the wait time may be in the emergency department. In general, prepare for a lengthy visit. This may mean you may need to make necessary arrangements for work, child care, and/or transportation. Click here to read more about what to expect in the emergency department. Be sure to bring: Health card Relevant prior test results (bloodwork or ultrasound records if you have them) Water bottle Snack Phone and phone charger Reading materials