The early weeks of pregnancy can be an anxious time, especially with a first pregnancy, after a long time trying, or after fertility treatment. Most pregnancies go on to develop normally, but sometimes a pregnancy does not continue.

Early pregnancy loss is a pregnancy that does not continue prior to 12 weeks, leading to a miscarriage. This is common and accounts for about 10% of all pregnancies. Late miscarriage occurs between 12 and 22 weeks and is a less common cause of pregnancy loss. Early pregnancy losses account for around 80% of pregnancy losses.

Ectopic pregnancy and molar pregnancy can also cause pain and vaginal bleeding in the first trimester. These are not normal pregnancies, and care needs to be tailored to each. Both are covered further down this page.

If you are early in pregnancy and thinking ahead, you may also find the planning your pregnancy page helpful.

Bleeding early in pregnancy is common and does not always mean you are having a miscarriage — it happens in many pregnancies that go on to be healthy. Even so, any bleeding in pregnancy should be checked, so the cause can be found and you can be supported.

An assessment may include an examination to check for bleeding and the size of your uterus, and you may be sent for:

• Ultrasound — to find where the pregnancy is, check that it is growing, and look for a heartbeat. This is often an internal (transvaginal) ultrasound in early pregnancy.
• Blood tests — to measure the pregnancy hormone hCG (human chorionic gonadotrophin), which normally rises in early pregnancy. A single reading is often repeated after about two days to see how it is changing.

Often no specific cause is found and the pregnancy continues normally. If the hCG is lower than expected or rising more slowly than usual, the pregnancy may not be developing normally, or it may be ectopic. If hCG is falling, this may mean a non-progressive pregnancy. Dr Mahadik will explain your results and what happens next.

A miscarriage is the loss of a pregnancy, most often in the first trimester. As it happens you may have vaginal bleeding and period-like pain and cramps, and pregnancy tissue may pass. It can be an emotionally challenging time, with a range of feelings of grief and loss that women may experience.

Miscarriage is common. Early pregnancy loss — miscarriage before 12 weeks — accounts for about 10% of all pregnancies, and makes up around 80% of all miscarriages. The true rate is likely higher, because some miscarriages happen very early, sometimes before a woman knows she is pregnant. It is nothing to be ashamed of, and in almost all cases nothing you did caused it.

Most early miscarriages happen because the pregnancy was not developing normally, usually due to a chromosomal change in the embryo that happened by chance. In these cases the pregnancy does not develop properly and nothing could have prevented it. A high fever can occasionally be a factor, though most minor infections are not harmful.

Miscarriage can happen to anyone, including very healthy women. It is a little more likely with:

• older age, as chromosomal changes become more common
• smoking, alcohol or recreational drug use
• some ongoing health conditions, such as poorly controlled diabetes or thyroid problems
• some conditions affecting blood clotting
• (fibroids can be a factor in some cases and would be assessed individually)

Since the majority of miscarriages occur due to a fault in the way the egg and sperm meet, leading to an abnormal number of chromosomes, these cannot be prevented. However, it helps to maintain healthy lifestyle practices like avoiding smoking and alcohol, having a healthy balanced diet, and regular exercise. Full guidance on staying well is on the antenatal care page.

You may hear different terms used:

• Threatened — some bleeding and pain, but the pregnancy is still continuing.
• Complete — all of the pregnancy tissue has passed.
• Incomplete — some pregnancy tissue has passed, but some remains in the uterus.
• Missed — the pregnancy has stopped growing but the tissue has not yet passed, and is often found at an ultrasound before any bleeding starts.

Once a miscarriage has begun, nothing can stop it. With an incomplete or missed miscarriage the tissue often passes on its own — an incomplete miscarriage usually within a few days, a missed miscarriage sometimes over up to three to four weeks. You may have spotting or bleeding during this time, then heavier bleeding with clots and period-like cramps as the tissue passes. You can take paracetamol for pain and use pads rather than tampons, which lowers the chance of infection.

Any care is aimed at helping the tissue pass safely and avoiding heavy bleeding or infection. Dr Mahadik will talk through the options so you can choose what is right for you. There are three approaches:

• Expectant management — Waiting for the pregnancy tissue to pass naturally. Bleeding and cramping usually start within one to two weeks, and some light bleeding can continue for around two weeks. It avoids medicines and surgery, but the timing is unpredictable and the wait can be emotionally draining.
• Medical management — Taking a medicine (misoprostol) that helps the cervix open and the uterus contract so the tissue passes, usually within a few hours to a day or two. It can bring heavier bleeding, cramping and sometimes nausea, and medicine can be given to help with these. Occasionally a second dose or a small procedure is needed. Do not start or stop any medicine without medical advice.
• Surgical management — A minor procedure (a suction curettage, sometimes called a D&C) to gently remove the remaining tissue, done under anaesthetic, usually as a day procedure. It is often recommended if there is heavy bleeding or signs of infection, or if you would prefer not to wait. Light bleeding and mild cramps are common for one to two weeks afterwards.

If you have a Rhesus-negative blood type, you may be offered an anti-D injection — Dr Mahadik will let you know if this applies to you.

While a miscarriage is passing, seek urgent care — call triple zero (000) for an ambulance if bleeding is heavy — if you have:

• very heavy bleeding, such as soaking a large pad every hour or two, or passing large clots
• a fever or chills
• severe tummy pain, or pain in your shoulder
• dizziness or fainting
• vaginal discharge that smells unpleasant

These can be signs of heavy bleeding or infection that need prompt treatment.

Ensure your pain is well managed with adequate pain relief, good nutrition and hydration, and seek support as needed. You may bleed for a couple of weeks, like a light period. Your next period usually returns about four to six weeks later, and the first one may be heavier than usual. A follow-up appointment about four to six weeks after your miscarriage is recommended, to check how you are recovering physically and emotionally.

You can become pregnant again very soon after a miscarriage, sometimes before your next period — so use contraception if you are not ready. Many people choose to wait until after a normal period, or longer, to allow time to recover. There is no right or wrong way to feel; grief and mixed feelings, including anxiety about a future pregnancy, are all common. When you feel ready, Dr Mahadik can support you in planning your next pregnancy.

Having one miscarriage does not usually mean you are likely to have another — most women who miscarry go on to have a healthy pregnancy. In Australia, having two or more miscarriages is called recurrent miscarriage, and it is uncommon. If this happens, tests can be arranged to look for a cause, and a future pregnancy may be watched more closely — see high-risk pregnancy care.

Normally, an egg is fertilised in the fallopian tube and then travels to the uterus, where the pregnancy develops. In an ectopic pregnancy the fertilised egg starts growing in the wrong place — most often in a fallopian tube, and less commonly in the ovary, cervix, a caesarean scar or elsewhere. Because a fallopian tube cannot stretch like the uterus, an ectopic pregnancy cannot continue safely, and it can cause the tube to bleed or rupture. It is a serious condition that needs prompt care.

Around 1 to 2 in every 100 pregnancies are ectopic. Often no cause is found, but it is more likely if you have:

• had a previous ectopic pregnancy
• a history of pelvic infection
• damage to the fallopian tubes, or previous pelvic or tubal surgery
• conceived through IVF
• become pregnant while using the mini-pill or an IUD

An ectopic pregnancy is usually found in the early weeks. See a doctor promptly, or go to your nearest emergency department, if you have:

• light to heavy vaginal spotting or bleeding
• sharp or one-sided tummy or pelvic pain
• pain in the shoulder tip or neck
• dizziness or fainting
• pressure in the back passage

An early ultrasound, along with blood tests, helps locate the pregnancy. If it is ectopic, it is treated without delay. If you have severe tummy pain, shoulder-tip pain, heavy bleeding, or feel faint, call triple zero (000) for an ambulance.

An ectopic pregnancy cannot be moved to the uterus or carried to term, and it needs treatment to prevent serious internal bleeding. Depending on how far along it is, how you are, and your hCG levels, the options are:

• Watchful waiting — if the pregnancy appears to be resolving on its own, with close follow-up blood tests. If symptoms worsen while waiting, seek emergency care.
• Medicine (methotrexate) — an injection that stops the pregnancy from growing, used when the ectopic pregnancy is small and the risk of bleeding is low. Sometimes a second injection, or surgery, is needed if it does not work.
• Surgery — usually keyhole (laparoscopic) surgery under general anaesthetic, needed if there is internal bleeding. The pregnancy is removed, usually along with the affected tube. Your ovaries are kept, and having one fallopian tube removed does not affect your hormones and does not usually prevent a future pregnancy.

Do not start or stop any medicine without medical advice.

It is generally advised to wait a couple of months after surgery, or a few months after methotrexate, before trying again — but pregnancy can happen sooner, so use contraception until you are ready. In a future pregnancy an early ultrasound (at around 5 to 6 weeks) is recommended to check the pregnancy is in the right place. Having had one ectopic pregnancy can raise the chance of another, so early checks matter.

Grief after pregnancy loss is real, and there is no timeline for it. You may feel sad, numb, angry or anxious, and partners can grieve too. Support is available, and asking for it is a sign of strength, not weakness. Dr Mahadik can talk with you and refer you to counselling or support services if that would help. You can also reach out to:

• Pregnancy, Birth and Baby — 1800 882 436 (7am–midnight, 7 days), for a maternal child health nurse
• SANDS (miscarriage, stillbirth and newborn death support) — 1300 072 637, 24/7
• Miscarriage Australia — information and resources at miscarriageaustralia.com.au

If you are struggling and need to talk to someone now, you can call Lifeline on 13 11 14.