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Expert Q&A

	By Aneema Van Groenou, M.D. General Medicine

Besides miscarriage, what other reasons may cause bleeding in the first trimester?

Less common causes of bleeding in the first half of pregnancy include infections such as Chlamydia or gonorrhea, or a rare condition called Gestational Trophoblastic Disease (GTD), a tumor that arises from the placenta and mimics the symptoms of pregnancy and occurs in one in 1,700 pregnancies. GTD presents with abnormally elevated levels of pregnancy hormones and bleeding. Its diagnosis is confirmed by ultrasound. Seeing your obstetrician to evaluate causes of painless bleeding is important since both infections and GTD need to be treated.

One of the most dangerous causes of bleeding in the first half of pregnancy is an ectopic pregnancy, or a pregnancy that implants outside the uterus, usually in the narrow fallopian tubes, which connect the ovaries and uterus. Ectopic pregnancy is usually found before 12 weeks of pregnancy (or 3 months) because as the pregnancy grows in its abnormal location, it causes severe pain. An ectopic pregnancy is dangerous because it can rupture and cause bleeding into the abdomen, causing the woman to become very ill very quickly.

If you have any bleeding early in pregnancy associated with any pain, see your doctor or go to the emergency room immediately to be evaluated for an ectopic pregnancy. Simply doing an ultrasound and confirming the location of the pregnancy within the uterus – where it belongs – virtually eliminates the risk of an ectopic pregnancy.

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