Complications of Early Pregnancy

Bleeding and pain in early pregnancy are common; while half of all women who experience bleeding in pregnancy do have an ongoing pregnancy, for the other half, bleeding is a sign of a significant problem. Any bleeding in pregnancy is therefore treated as a gynecological emergency and requires immediate investigation.

For roughly 50% of women who have bleeding in early pregnancy, the underlying cause is likely to lead to the loss of the pregnancy; the bleeding may be the first signs of miscarriage, or it may indicate an ectopic pregnancy.

In the event of blood loss or pain in early pregnancy, Yinka Akinfenwa would want to see you as soon as possible. With many years experience in this field, he brings expertise and sensitivity to each individual case, and offers treatment, including surgery, wherever necessary, as well as follow-up consultations.


Caring for you

Yinka will be here to thoroughly investigate your health and your pregnancy. With Yinka, you will be in the safe hands of an experienced obstetrician. He is aware of the range of emotional reactions when a pregnancy does not go as planned; and is able to refer you to specialist counsellors who are experienced in supporting couples in early pregnancy and when there are problems, including pregnancy loss. Yinka holds clinics at Viveka Health Practice (NW8) where an experienced team of medical and complementary specialists in pregnancy care work together. He can put you in touch with a counsellor or therapist depending on your wishes. 


Ectopic pregnancy

When there is pain in early pregnancy associated with bleeding (particularly if the bleeding is light), it is important to exclude an ectopic pregnancy. An ectopic pregnancy occurs where an egg is fertilized and implants outside the uterus, in one of the fallopian tubes. This is not a viable pregnancy, and requires urgent removal.

Yinka will begin with a clinical assessment, which involves conducting a physical examination and finding out about your personal medical history, including the date of your last menstrual period and the timing of abdominal pain in relation to the vaginal bleeding. Ultrasound scanning is useful, and a blood sample can be tested for progesterone and the hormone of pregnancy (Beta HCG) to assist with an accurate diagnosis. On some occasions serial assays of the blood level are required.
Sometimes a laparoscopy is required to make an accurate diagnosis; treatment can then be carried out at the same time.

If the diagnosis of an ectopic pregnancy is confirmed, urgent surgical treatment is needed. Yinka will explain the treatment options to you. In a large number of cases there is a significant risk that part of all of the fallopian tube may be lost.

The risk factors for ectopic pregnancy include a previous condition or surgery that may have caused damage to the fallopian tubes, such as pelvic infection, adhesions, endometriosis or previous to tubal surgery. Some types of assisted fertilization can also raise the likelihood of ectopic pregnancy.


Miscarriage

Miscarriage occurs in between 10 to 15% of known pregnancies. Many occur between weeks 4 and 6 of gestation.


Threatened miscarriage

Light bleeding in early pregnancy without pain suggests a threatened miscarriage. If this occurs, Yinka will give you a clinical examination to confirm your uterus is the correct size for the period of gestation and your cervix is closed. An ultrasound scan is the best way to confirm the viability of the pregnancy. The light blood loss may be a sign of miscarriage, but does not always mean miscarriage is inevitable. For a pregnancy at 12 weeks gestation with confirmed viability on ultrasound scan, the risk of pregnancy loss is about 1%.


Inevitable miscarriage

The typical signs of an inevitable miscarriage are intense pain and significant, often heavy, bleeding. A clinical examination would reveal that the cervix is open; and some pieces of pregnancy tissue may be passed.

When the process of miscarriage has begun, one option is to allow spontaneous completion of the natural process; this may take on occasion up to 48 hours; most women choose to allow this to happen at home. The alternative is to have a surgical evacuation of the remaining parts of the pregnancy, a procedure lasting about 10 minutes that is usually carried out under general anaesthetic (the medical term for this is ERPC or ‘evacuation of the retained products of conception’).


Missed miscarriage

A missed miscarriage is so called because it becomes apparent, completely unexpectedly, at a routine ultrasound examination in early pregnancy. The ultrasound scan may show that the foetus has died, or has failed to develop at all.
In this situation one option is to allow spontaneous completion of the natural process. If you choose to wait for the process to complete naturally, you will experience an eventual miscarriage with bleeding and, typically, pain. Another option is to use medication to induce the process; again, you will experience a miscarriage. Alternatively, you may opt for a surgical evacuation, a ten-minute operation carried out under general anaesthetic as a day case.
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