Miscarriage | Sydney obstetrician Dr Anu Mahadik

Miscarriage

Miscarriage & early complications | Sydney obstetrician Dr Mahadik

What are early pregnancy complications?

Early pregnancy can be a worrying time for women and couples, especially if this is your first pregnancy or you have been trying to fall pregnant for a long time or used infertility treatments.

There are some common complications early in pregnancy. Most of these are due to a pregnancy not attaching or forming properly. These include:

  • Miscarriage
  • Ectopic pregnancies.
  • Molar Pregnancy
  • Excessive nausea/vomiting

Bleeding in pregnancy | Sydney obstetrician Dr Mahadik

Bleeding in early pregnancy

If you are bleeding early in your pregnancy you may understandably be concerned and worried about the baby. It is important to note that bleeding does not always mean that you are having a miscarriage. Bleeding early during pregnancy is common and happens to a quarter of women – many who have healthy babies. However, if you are bleeding during pregnancy you should see a healthcare professional so they can investigate if there is a more serious cause behind it.

Tests for bleeding during early pregnancy

We will conduct an internal examination to look for signs of any obvious bleeding and the size of your uterus. You may be sent for additional tests:

  • Ultrasound – You may be sent for an ultrasound to locate where the pregnancy is growing and that it is growing. This may be an internal Ultrasound. This can also check for a heartbeat.
  • Blood tests – to check your levels of the pregnancy hormone hCG (human Chorionic Gonadotropin) which changes depending on how pregnant you are:
    • If hCG is lower than expected your pregnancy may not be growing normally. This will be repeated after 2 days.
    • If hCG is rising slower than usual you may be miscarrying or have an ectopic pregnancy. If hCG is falling this usually means the pregnancy is ending and you will miscarry.

What causes bleeding during early pregnancy?

The tests may find no reason behind your bleeding and the pregnancy will likely continue as normal. Or you may be having a miscarriage or an ectopic pregnancy.
Miscarriage: Causes & risks Sydney obstetrician Dr Mahadik

Miscarriages | Sydney obstetrician Dr Mahadik

Miscarriage

A miscarriage happens when your pregnancy is not developing normally and may stop growing completely. Miscarriages can cause bleeding, and the tests to investigate bleeding will indicate if you have had or may soon have a miscarriage. The pregnancy tissue may pass out of your body. Besides bleeding, you may feel period-like pain and cramps.
Miscarriages are very common (1 in 5 women) and nothing to be ashamed about although it is normal to be disappointed or upset.
Sometimes this happens very early in a pregnancy before you even know that you are pregnant. Most miscarriages happen in the early weeks of a pregnancy (the first 12 weeks). Although sometimes a pregnancy will appear to be developing normally and for an unknown reason a miscarriage may happen weeks later.

What causes a miscarriage?

If a pregnancy was not going to be viable, you will like to miscarry. You may have had a miscarriage because the chromosomes in the embryo were abnormal. The pregnancy does not develop properly in these cases. Nothing could have been done to prevent this.

You may also have a miscarriage if you had a high fever (but minor infections are typically not harmful). There are very small risks of miscarriage with tests like amniocentesis.

Who is at a greater risk of a miscarriage?

Miscarriages are more common in:

  • Older women as the risk of chromosomal abnormalities is more common
  • Women who smoke or drink in the first 12 weeks of pregnancy (this is why you should quit smoking and drinking before you fall pregnant as you may not know when you conceive)
  • Women with uncontrolled diabetes, fibroids or thyroid problems
  • Women with medical conditions affecting blood clotting.

How can I prevent a miscarriage?

Miscarriages can happen to all women, even the very healthy. However, being healthy will increase your chances of a healthy pregnancy. During pregnancy you should:

  • Avoid alcohol and smoking
  • Moderate your caffeine intake
  • Avoid contact with anyone with a serious infectious illness
  • Take paracetamol if you have a fever

How do I know if I have had a miscarriage?

If you have had bleeding or pain during your early pregnancy then this needs to be assessed.
This can be further assessed by:

  • Ultrasound
  • Blood tests ( HCG level)

What are the different types of miscarriages?

  • Threatened – This is associated with some bleeding and pain but pregnancy is still continuing.
  • Complete – All the pregnancy tissue has passed
  • Incomplete – Some of the pregnancy tissue has passed but some is still inside the uterus
  • Missed – The pregnancy has stopped growing but the pregnancy tissue is still in the uterus, possibly including an amniotic sac.

What happens to the pregnancy after a miscarriage?

If you have an incomplete or missed miscarriage the tissue will eventually pass naturally. An incomplete miscarriage can take a few days and a missed miscarriage may take 3-4 weeks. During this time you may have spotting or bleeding. When the tissue does pass you will have heavier bleeding and period-like cramps. There is also medication available that can make passing the pregnancy tissue faster.

You will likely have bleeding with clots and cramps when you are passing the pregnancy tissue. You can take paracetamol for pain and use pads (not tampons) for bleeding.

Once the pregnancy has passed these symptoms should stop. If the bleeding continues and is heavy you may need treatment. You need immediate medical attention if you have:

  • Increased bleeding (going through two or more pads per hour) or have passed golf ball sized clots
  • A fever or chill
  • Severe abdominal or shoulder pain
  • Dizziness or fainting
  • Unpleasant smelling vaginal discharge


If you have heavy bleeding or signs of an infection, particularly with a missed miscarriage you may need a dilatation and curettage (D&C) to remove the remaining pregnancy tissue. This is a procedure performed as an inpatient under general anaesthetic.

You should avoid intercourse until the bleeding stops. You should see your GP 4-6 weeks after your miscarriage for a check-up. You should use contraceptives if you do not want to get pregnant again yet.Your next period may be delayed for 4-6 weeks.
While you can get pregnant immediately you may wish to wait until after the next normal period. Some couples will feel grief and need time to adjust before trying again. There is no right or wrong way to feel after your miscarriage. Grief is common. You may have mixed feelings and anxiety about becoming pregnant again. There are support groups and counsellors that we can refer you to for help.
If you have had a previous miscarriage, it is unlike they you with miscarry again unless you have underlying health issues. If you have 3 or more miscarriages in a row you should have testing to investigate the causes.

What is an ectopic pregnancy?

In a normal pregnancy, conception begins when the egg and sperm meet in the fallopian tube. The fertilised egg then travels down into the uterus where it develops.

In an ectopic pregnancy the fertilised egg starts growing in the wrong place. This is commonly inside the fallopian tube. More rarely an ectopic pregnancy can be found in other positions like the ovary, cervix, scar tissue from a previous C-section, or in other parts of the belly.

As the pregnancy starts to grow it will stretch the fallopian tube which is very painful. This can cause pain in the lower belly or vaginal bleeding. This can also cause the tube to tear or burst which requires urgent surgery to deal with serious internal bleeding. Sometimes an ectopic pregnancy will shrink and resolve on its own.

Ectopic pregnancies happen soon after conception and are diagnosed in the early weeks of a pregnancy. This is because the fallopian tube cannot grow and expand like the uterus does.
One in every 100 pregnancies are ectopic

Often no reason is found for this, but they tend to be more common if you have:

  • Conceived through IVF
  • A history of pelvic infection
  • Damage fallopian tubes
  • Previously had surgery (C-section, removal of ovarian cysts or appendix)
  • Become pregnant while using the mini-pill or an IUD

If you have an ectopic pregnancy, you may experience:

  • Light to heavy vaginal spotting or bleeding
  • Sharp waves of pain in the abdomen, pelvis, shoulder, or neck.
  • Dizziness or fainting
  • Rectal pressure


An early ultrasound will allow us to locate the pregnancy and determine if it is ectopic. An ectopic pregnancy is very serious and if found you will be treated immediately.

An ectopic pregnancy cannot be saved and carried to term. It must be treated to stop it from growing. If you do not do this you will have serious internal bleeding. Ectopic pregnancies can occasionally cause death. If you have an ectopic pregnancy that appears to be miscarrying we may ask you to ‘wait and see’. Follow up blood tests will be arranged to track the progress of the pregnancy ending. If you are waiting and get worsening symptoms you need to immediately seek emergency medical attention:

  • Much heavier bleeding
  • Dizziness or fainting
  • Severe abdominal pain
  • Shoulder tip pain


We may prescribe you medication to stop the pregnancy from growing. This is an injection and is used if the ectopic pregnancy is very small and you are at a low risk of internal bleeding. Rarely the injection may not work and you may need follow up injections or surgery.

If you are bleeding internally you may require surgery. This is usually keyhole surgery (laparoscopy) under general anaesthetic. The ectopic pregnancy along with the tube is usually removed. Your ovaries are conserved and removing one of your fallopian does not affect your hormones and your future fertility.

It is generally recommended that you wait two months after surgery and 3-4 months after medication before getting pregnant again. However, it is possible to get pregnant again straight away so you should use contraception.

If you do fall pregnant again it is recommended that you have an early ultrasound (at 5 – 6 weeks) to ensure the pregnancy is in the right place.

You may be at an increased risk of having another ectopic pregnancy if you have had one before. This is because you may have an underlying problem that caused the first ectopic pregnancy.

Antenatal care Sydney obstetrician

Frequently asked questions about pregnancy care

Across all trimesters of your pregnancy you should:

  • Avoid foods that may contain listeria bacteria as this can cause fetal death (unpasteurised milk, soft cheeses, cold processed meats, pre-cut fruit and salads, pâté, raw seafood and smoked seafood)
  • Wash raw vegetables and thoroughly cook all foods from animals to avoid listeria
  • Avoid eating uncooked or undercooked meat to avoid toxoplasmosis
  • Avoid cleaning cat litter boxes
  • Quit smoking, alcohol and other drugs
  • Avoid exposure to secondhand smoke
  • Reduce your caffeine intake
  • Discuss all over-the-counter drugs you take or are prescribed with your doctor or pharmacist
  • Eat a healthy balanced diet with plenty of water
  • Regular low intensity exercise at least 3 times a week

Sydney Obstetrician Norwest and St George Private Hospitals

Consulting at Norwest and St George Private Hospitals

My consulting rooms are at Burbank Place, Norwest which is near Norwest Private Hospital. If you are preparing for your antenatal care and looking for the best and most suitable solution, you can count on my practice to help you. If you live northwest of Sydney CBD, or near the M2 or M7, you may find my practice in Norwest suitable for your antenatal care consultations.

If you live in the Sydney CBD, or south of Sydney, you may be best served by coming to my rooms in Kogarah, at St George Private Hospital Medical Suites.

I come from a family of doctors and it has always been my intuitive first choice to become an Obstetrician and Gynaecologist. I basically grew up in it, with my father being one of the co-founders of a series of IVF clinics in India. Care for mothers and the babies they are expecting has always been my first nature and I am grateful for being able to serve my patients in their journey.
So if you are in that phase where you are not sure how to choose a private obstetrician in Sydney, let’s have a chat so we can plan your antenatal care together.

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