Bleeding following pregnancy loss before 6 weeks' gestation

Abstract

Background: Pregnancy loss before 6 weeks' gestation is common, but little has been reported about the associated bleeding. We compared women's bleeding following a pregnancy loss before 6 weeks' gestation with their typical menstruation.

Methods: Women provided daily urine samples while trying to become pregnant and recorded the number of pads and tampons used each day. Thirty-six women had complete bleed data for a loss before 6 weeks' gestation and one or more non-pregnant cycles.

Results: Mean bleed length following a pregnancy loss was 0.4 days longer than the woman's average menstrual bleed (P = 0.01), primarily because of more days of light bleeding. Although there was no overall increase in the total number of pads plus tampons used, women with losses bled less than their typical menses following pregnancies of very short duration and more than usual for the pregnancies lasting the longest.

Conclusions: Overall, the bleeding associated with pregnancy loss before 6 weeks' gestation is similar to menstrual bleeding and unlikely to be recognized as pregnancy loss. The intriguing finding that pregnancies of very short duration were associated with less bleeding than the woman's typical menses might reflect endometrial factors associated with loss.

Figure 1

Mean daily pad plus tampon use total by day of bleed period for 36 women for bleeds following their early pregnancy losses (solid line) versus their cycles with no detected conception (dashed line). Mean daily pad plus tampon totals are the across women means of each woman’s mean values. Every menses contributes data for all 12 days (zero values after bleeding ends).

Figure 2

Plot of each woman’s bleed length (days) for the bleed period following her early pregnancy loss (mean value used for the two women with two losses each) versus her mean bleed length (days) for her bleed periods following cycles with no detected conception (N = 36 women). Dashed line is line of equality.

Figure 3

Plot of the within-woman difference in total number of pads plus tampons used during bleed period (total number used for bleed following early pregnancy loss minus mean of totals for bleeds following cycles with no detected conception) versus the maximum hCG value (shown on a log scale) obtained for the pregnancy that was lost (N = 36 women). Spearman correlation coefficient = 0.37 (P-value = 0.02).