Call your doctor or midwife immediately if you ever notice unusual symptoms such as bleeding or cramping during pregnancy. Your practitioner will examine you to see if the bleeding is coming from your cervix and check your uterus. She may also do a blood test to check for the pregnancy hormone hCG and repeat it in two to three days to see if your levels are rising as they should be.
If you're having bleeding or cramping and your practitioner has even the slightest suspicion that you have an ectopic pregnancy, you'll have an ultrasound right away. If there's no sign of a problem but you continue to spot, you'll have another ultrasound at about 7 weeks.
At this point, if the sonographer sees an embryo with a heartbeat, you have a viable pregnancy and your risk of miscarrying is now much lower, but you'll need to have another ultrasound later if you continue to bleed. If the sonographer sees an embryo of a certain size but no heartbeat, that means the embryo didn't survive.
If the sac or the embryo is smaller than expected, though, it might just be that your dates are off and you're not as far along as you thought. Depending on the circumstances, you may need a repeat ultrasound within one to two weeks and some blood tests before your caregiver can make a final diagnosis.
If you're in your second trimester and an ultrasound shows your cervix is shortening or opening,
(This is assuming your baby appears normal on the ultrasound and you have no signs of an intrauterine infection.) Cerclage isn't without risk, and not everyone agrees on what might make you a good candidate for it.
If you're showing signs of a possible miscarriage, your doctor or midwife may prescribe bedrest in hopes of reducing your chances of miscarrying — but there's no evidence that bedrest will help. She may also suggest you not have sex while you're having bleeding or cramping. Sex doesn't cause miscarriage, but it's a good idea to abstain if you're having these symptoms.
You may have light bleeding and cramping for a few weeks. You can wear sanitary pads but no tampons during this time and take acetaminophen for the pain. If you are miscarrying, the bleeding and cramping will likely get worse shortly before you pass the "products of conception" — that is, the placenta and the embryonic or fetal tissue, which will look grayish and may include blood clots.
If you can, save this tissue in a clean container because your caregiver may want to examine it or send it to a lab for testing to try to find out why you miscarried. In any case, she'll want to see you again at this point, so call her to let her know what's happened.
