First Trimester Bleeding
First trimester bleeding is essentially the bane of my existence as a triage midwife. I get so frustrated with the amount of offices that send their patients into triage with any sign of spotting. The offices are unable to fit patients into their office schedule for evaluation so the patient is left with a hefty ER bill for something that could have been avoided! OB triage is essentially the ER for pregnant women. As a provider in triage, I am MORE than happy to take care of you. I'm happy to provide education, reassurance, and support for you. But coming to triage at any sight of blood is not a good use of resources- the hospital system's or yours!
So let's chat about it. When do you worry about spotting in the first trimester and when do you just watch and wait?
Okay so, you had a little bit if vaginal bleeding. Now what? Let's go through the steps together:
Do NOT. I repeat, do NOT get on Google! Google will only make you more anxious.
Take a deep breath. Most people's minds go straight to worst case scenario and miscarriage but there are SO many reasons for first trimester bleeding. Try to relax.
Observe the quantity and quality of the blood. What color is it? Are there clots? Is it thin and mucusy or is it thicker? Is it just some pink spotting when you wipe? Do you have to wear a pad?
Do you have any abdominal cramping or back pain?
Put on a pad so you can watch for an increase in bleeding.
Were there any preceding events before the bleeding. One of the biggest culprits is recent intercourse. Your cervix is extra vascular during pregnancy which means it is more likely to bleed. Even if you don't normally spot after intercourse outside of pregnancy, you might during pregnancy!
Call your provider and let them know what's going on. Usually you can wait it out until your provider can see you in the office to evaluate you and to do an ultrasound.
If you're completely saturating a pad an hour and you have to keep changing that pad or if you are passing LARGE blood clots (the size of a baseball or bigger), you need to go to the ER. That is too much blood!
Most common reasons for bleeding in the first trimester:
Intercourse
Subchorionic hemorrhage- an area of separation where the placenta attaches to the uterus. These are more common than people think and usually do not lead to a miscarriage. However, if they are really large, they can lead to a miscarriage.
Implantation bleeding
Yeast infection or bacterial vaginitis
STD
Nonviable pregnancy (miscarriage)
When in doubt, call your provider before you rush in to the ER. You chose them as a provider for a reason and most of them have after hours call lines even if their office is closed.
