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Speaker 1: Welcome to the kick Your Expert led podcast, helping you

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Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming

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Speaker 1: a parent.

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Speaker 2: On the podcast and our online pregnancy program grow My Baby,

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Speaker 2: we share my experience of helping more than four thousand

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Speaker 2: babies to be born.

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Speaker 1: And our experience of running a women's health clinic and

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Speaker 1: parenting four boys.

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Speaker 2: We're here to help everyone to feel empowered in pregnancy

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Speaker 2: and birth with real life, practical information. Of this is

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Speaker 2: Dr Patam here with Bridget and today it's bleeding in

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Speaker 2: early pregnancy. Bleeding and spotting in early pregnancy can be

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Speaker 2: really frightening. We've got our own experience of Bridget having

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Speaker 2: a big bleed when she was seven weeks pregnant, and

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Speaker 2: it came at such a shock, and I remember feeling

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Speaker 2: anxious and thinking we'd lost the baby, and even with

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Speaker 2: my expert knowledge, being really scared. This episode is about

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Speaker 2: giving you the knowledge so you know what to ignore

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Speaker 2: and what to have investigated, and to help give you

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Speaker 2: that sense of calm as you try and navigate the

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Speaker 2: waters of early pregnancy.

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Speaker 1: So Dr Pat this week, have you got any little titbits.

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Speaker 2: For us some more good news? This week two of

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Speaker 2: my patients who've been having ovulation induction got pregnant this week.

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Speaker 1: Oh that's very exciting.

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Speaker 2: That's great. So these are both women with polcistic ovarian

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Speaker 2: syndrome who have needed some medication to help them get pregnant,

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Speaker 2: and as we've covered in a previous podcast, it can

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Speaker 2: be triggered to get the dose right. We want enough

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Speaker 2: to get pregnant and not enough to have twins. That's

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Speaker 2: the ideal amount of ovulation induction medication to give twin.

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Speaker 2: Pregnancies can be very happy and very normal, but they

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Speaker 2: can also be a little complex, and the right way

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Speaker 2: to go with ovulation induction is to try and get

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Speaker 2: people pregnant one baby at a time. So we've knowed

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Speaker 2: that twice this week. I'm pretty happy about that.

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Speaker 1: That's good. And coincidentally, these women don't know each other,

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Speaker 1: do they No, No, But in in the waiting room,

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Speaker 1: like have they sort of keep going, how you going? Yeah?

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Speaker 2: I don't know what people talk about in the waiting room.

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Speaker 2: I'm never in there, but I do know. I mean,

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Speaker 2: I guess the pregnant women who can tell that the

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Speaker 2: other woman's pregnant would always stay low and ask where

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Speaker 2: you're up to I don't know. Maybe I don't know

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Speaker 2: what the guyny patients talk about or the people when

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Speaker 2: I'm pregnant, ye talk about them. I'm never out there.

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Speaker 1: Yeah, okay, So all of you who are listening and

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Speaker 1: you're wondering about ovulation, I would suggest you pop back

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Speaker 1: to episode two where we talk about what is ovulation

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Speaker 1: and what is opulation induction? Anyway, So here we are.

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Speaker 1: We are talking about bleeding in early pregnancy, which is

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Speaker 1: a really anxious time when you have a spot or

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Speaker 1: you might have a bright red bleed or you know,

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Speaker 1: there's so many variations that you get. You know, there's

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Speaker 1: a lot of discharge, isn't there when you're in early pregnancy.

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Speaker 1: So Patty, I'm going to talk about what a woman

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Speaker 1: might experience her periods late. She's had her pe on

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Speaker 1: a stick and it's come back positive, but she's got

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Speaker 1: some spotting. What's going on there.

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Speaker 2: So that's a really common situation that we see at

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Speaker 2: work a lot, and it's an anxious time for the

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Speaker 2: couple because one of the possibilities is early miscarriage, and

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Speaker 2: that's where my mind goes to first. Thankfully, most of

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Speaker 2: the time, when there's bleeding in early pregnancy. It's not

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Speaker 2: a miscarriage, actually, but we need to keep an eye

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Speaker 2: on that situation until we can reliably reassure that woman

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Speaker 2: that things are fine. So some of the possibilities are

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Speaker 2: that it's something called an implantation bled which is, remember

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Speaker 2: the egg comes out of the ovary, it's picked up

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Speaker 2: by the trumpet end of the fallopian tube, and about

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Speaker 2: halfway down the tube it meets up with the sperm

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Speaker 2: coming up the other way. Fertilization, where the sperm penetrates

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Speaker 2: the egg, happens in the tube and then the tube

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Speaker 2: will push the fertilized egg down back into the body

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Speaker 2: of the uterus where it implants, and all of that

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Speaker 2: takes time. So somewhere around that sort of four to

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Speaker 2: five week mark in early pregnancy, four to five weeks

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Speaker 2: since the last period, the fertilzed egg is literally implanting

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Speaker 2: into the lining of the uterus which has got all

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Speaker 2: thick to be ready to receive it. And that process

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Speaker 2: can cause bleeding, and sometimes that's all the bleeding is.

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Speaker 1: And what you know, we get a bit obsessed with

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Speaker 1: the type of bleeding. So is that just like brown spotting,

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Speaker 1: or is it like bright red or what should a

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Speaker 1: woman expect from implantation bleeding.

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Speaker 2: That's usually pink spotting pink. Yeah, but any bleeding needs

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Speaker 2: some attention because we just don't know whether it's a

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Speaker 2: miscarriage with an implantation bleed or nothing or what have you.

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Speaker 2: So the appropriate things to do is to catch up

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Speaker 2: with your local dock or you might be seen in

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Speaker 2: the hospital emergency department after ours and they'll check you

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Speaker 2: over and make sure that you're basically well, and then

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Speaker 2: it's to work out what's going on with the pregnancy.

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Speaker 2: And of course the appropriate test is ultrasound. If the

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Speaker 2: ultrasound shows a pregnancy that's in the uterus with the

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Speaker 2: heart beating, regardless of the cause of the bleed, we

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Speaker 2: know things are fine. Yeah, And if it shows an

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Speaker 2: empty uterus, or if the woman's very unwell with pain,

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Speaker 2: or a dozen different possible scenarios, then each of those

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Speaker 2: has got their appropriate further testing and investigation.

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Speaker 1: Yeah. I love that image that you've just put in

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Speaker 1: my mind of the egg, you know, on its journey

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Speaker 1: down the fallopian tube, and you know, everything being pulsed

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Speaker 1: towards to meet the sperm, and you know, even the

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Speaker 1: image of the fertilized egg sort of burrowing in to

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Speaker 1: the uterus lining like that. You know, it's just such

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Speaker 1: beautiful imagery.

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Speaker 2: It's a beautiful thought.

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Speaker 1: Yeah. Yeah, And sometimes though it doesn't quite go to

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Speaker 1: plants it and the fertilized egg might just hang around

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Speaker 1: too long in the Filippian.

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Speaker 2: Tube and try and implant it, try and plant in

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Speaker 2: the Floppian tube. And that's an ectopic pregnancy. And that's

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Speaker 2: one of the things that needs to be seriously considered

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Speaker 2: in when there's bleeding in early pregnancy. So with a

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Speaker 2: combination of ultrasounds and some quantitative beater hCG levels and

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Speaker 2: that gives the number the blood test, we can work

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Speaker 2: it out.

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Speaker 1: So the blood test will tell us whether it's an ectopic.

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Speaker 2: Will it not all by itself, But it's about building

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Speaker 2: a picture where we say, okay, what can we see

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Speaker 2: on ultrasound? What's the blood test telling us? And there's

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Speaker 2: almost a flow chart that helps you work the answer out.

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Speaker 1: Yeah, And if we're investigating an ectopic pregnancy, is there

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Speaker 1: a prime time for an ectopic.

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Speaker 2: Well, an ectopic pregnancy will usually only come to light

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Speaker 2: when it either bursts out of the tube. It it's

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Speaker 2: implant in the tube and it's got too big and

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Speaker 2: it bursts out, and that might happen at seven, eight

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Speaker 2: or nine weeks pregnancy, or when it's trying to implant

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Speaker 2: somewhere where it shouldn't implant. It causes bleeding, and the

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Speaker 2: bleeding tracks down through the cavity.

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Speaker 1: And out the vagina, and that could be it, I

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Speaker 1: don't know, six or seven weeks, yes.

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Speaker 2: Exactly, Yeah, and that might happen so early, even before

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Speaker 2: the ectopic pregnancy has got an obvious appearance on ultrasounds.

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Speaker 1: Okay, So if you have had a suspected ectopic pregnancy,

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Speaker 1: how is that treated?

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Speaker 2: Well? Briefly, if an ectopic pregnancy has been proven, there

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Speaker 2: are a couple of different types. There might be a

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Speaker 2: pregnancy that's sitting in the fallopian tube and it's known

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Speaker 2: to be there through the testing, but it hasn't burst

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Speaker 2: out the tube, and they can often be treated. Sometimes

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Speaker 2: they will miscarry by themselves, and sometimes that's a process

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Speaker 2: that just needs to be observed and the blood hormone

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Speaker 2: levels followed back to zero. They can be treated with

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Speaker 2: medication these days, a medication that works a little bit

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Speaker 2: like chemotherapy and goes in there and dissolves the cells,

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Speaker 2: and that can avoid an operation in some situations. But

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Speaker 2: if the ectopic pregnancy has burst out of the tube

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Speaker 2: and it's bleeding and the woman is very un well,

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Speaker 2: then obviously that needs to be treated with an emergency

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Speaker 2: keyhole operation to go in through the belly button and

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Speaker 2: fix the bleeding and often remove the tube.

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Speaker 1: It's dreadful. We've had a very good friend who who

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Speaker 1: has had antopic pregnancy and she looked dreadful. It's obvious,

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Speaker 1: isn't it if you've got a burst.

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Speaker 2: Yeah. Most people with a burst ectopic look very unwell.

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Speaker 1: Yeah.

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Speaker 2: Yeah, and that's a hospital emergency department type scenario.

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Speaker 1: Yeah, and over sort of what period of time if

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Speaker 1: you feel like symptoms are coming along, where are you

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Speaker 1: feeling those symptoms.

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Speaker 2: Of an ectopic of eruption deec topic? Yeah, well, I

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Speaker 2: think that that needs to be considered by patients and

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Speaker 2: by doctors of anyone who's known to be pregnant and

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Speaker 2: has a bleeding and severe perfect pain.

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Speaker 1: Okay, so it's not specifically one sided or no, its

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Speaker 1: just incredible pain.

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Speaker 2: So pain, bleeding and known to be pregnant. Yeah, and

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Speaker 2: we got to look into that.

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Speaker 1: Yeah. So there's lots of reasons why somebody might bleed

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Speaker 1: that doesn't lead to a miscarriage, But what are some

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Speaker 1: of those reasons.

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Speaker 2: Well, in the early pregnancy, what's happening is that a

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Speaker 2: million little blood vessels are connecting up between the pregnancy

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Speaker 2: and the lining of the mother's uterus and the and

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Speaker 2: it's miraclet on all the time. It probably does bleed

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Speaker 2: all the time, and we just don't see most of them,

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Speaker 2: so a lot of that bleeding is harmless. An ultrasound

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Speaker 2: can be used in that setting to show people that

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Speaker 2: the pregnancy is carrying on fine, that the source of

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Speaker 2: the bleeding can't be seen, there's not enough blood to

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Speaker 2: show up on ultrasound, and that the baby is fine.

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Speaker 2: And that's what usually happens if a woman presents to

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Speaker 2: a hospital emergency department with bleeding and early pregnancy. And

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Speaker 2: it's one of the reasons why we like to have

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Speaker 2: a scanner in the department so we can scan people

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Speaker 2: on the spot.

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Speaker 1: And so you're fine, yeah, to go home. Yea, I

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Speaker 1: know this because you know we're in the same household.

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Speaker 1: But you do get some questions, some phone calls at

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Speaker 1: different times of the day and night, where someone's had

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Speaker 1: a bright red bleed after sex.

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Speaker 2: Yep, So, bleeding after sex in pregnancy worries people as

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Speaker 2: well because they again think it's a miscarriage. It's usually not.

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Speaker 2: It might be so bleeding after sex in pregnancy needs

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Speaker 2: an ultrasound to investigate see how the pregnant is going,

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Speaker 2: and if everything's fine, then we usually advise those couples

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Speaker 2: to stick clear of sex for a couple of weeks,

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Speaker 2: wait for everything to settle down, and then reintroduce sex

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Speaker 2: again and see how we go.

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Speaker 1: And you know, we do play the blame game a

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Speaker 1: little bit. If by chance we do then go on

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Speaker 1: and have a miscarriage, we look back on all those

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Speaker 1: things that caused miscarriage. Do you think that sex does

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Speaker 1: cause miscarriage?

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Speaker 2: No? No, I think that's very clear that it doesn't.

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Speaker 2: We don't know what causes a lot of miscarriages, but

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Speaker 2: we do know that it's usually got something to do

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Speaker 2: with the sperm and the egg not coming together properly

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Speaker 2: in the first place. So if we think about the

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Speaker 2: all the DNA from the sperm and all the DNA

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Speaker 2: from the egg, they have to come together and be

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Speaker 2: connected up like a giant zip and as that zip

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Speaker 2: goes up, mistakes can happen. The wrong bits of DNA

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Speaker 2: hook up with the wrong bits of DNA, and we

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Speaker 2: wind up with a with an early pregnancy that's capable

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Speaker 2: of surviving until five or six or seven weeks, but

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Speaker 2: not beyond that. And that's the cause of most early

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Speaker 2: pregnancy loss. And whilst it's very sad, there's nothing that

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Speaker 2: can nothing that can really be done to prevent those ones.

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Speaker 1: And I think that's really important point to make because

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Speaker 1: a lot of women sort of blame themselves or their

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Speaker 1: situation or their stress at work or whatever it might be,

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Speaker 1: but actually, you know, there's no control over how that

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Speaker 1: DNA might zip up. That's a really good analogy. I

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Speaker 1: like that idea.

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Speaker 2: That's right, and there is no control over that. And

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Speaker 2: I think it's super important that people understand that miscarriage

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Speaker 2: isn't their fault. I saw this beautiful thing on in

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Speaker 2: the internet somewhere once. It just a woman holding up

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Speaker 2: a sign that's said, presumably to her caregivers, thank you

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Speaker 2: for saying that the miscarriage wasn't my fault. And she

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Speaker 2: just needed to be told that because we're human beings

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Speaker 2: and we tend to blame ourselves for things.

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Speaker 1: And look for causes, and look for causes, that's right.

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Speaker 2: It can be very frustrating to people when a clear

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Speaker 2: cause of their presence loss isn't found, so then they

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Speaker 2: start saying, well, it must have been something I did

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Speaker 2: or didn't do.

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Speaker 1: That's right. And miscarriage is pretty common, isn't it.

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Speaker 2: Absolutely so, a first timemester, pregnancy loss is extremely common.

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Speaker 2: And when I see people with a sad first semester miscarriage,

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Speaker 2: they will tell their family and friends, and at that

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Speaker 2: point their family and friends will go, oh, yeah, that

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Speaker 2: happened to us as well, And thankfully, most people recover

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Speaker 2: from it very well. Most people who were in good

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Speaker 2: psychological health will accept that the pregnancy loss happened. They

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Speaker 2: will feel very sad about it, in a great sense

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Speaker 2: of disappointment at the start, but that passes in as

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Speaker 2: little as two weeks. And I see people two weeks

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Speaker 2: later for that very reason, because I want to make

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Speaker 2: sure that they're on the right track to emotional recovery,

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Speaker 2: and people at two weeks are very different. Most people

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Speaker 2: are improving day by day. They've been able to contextualize

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Speaker 2: the early prudency loss is something that's very sad, but

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Speaker 2: they're already hopeful for the future and almost ready to

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Speaker 2: start trying again.

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Speaker 1: And I've heard you say before you've got a nice

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Speaker 1: little phrase which is something like you might always remember.

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Speaker 2: Oh yeah, yeah, what is that again? Well, i'd say,

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Speaker 2: I just say to people that the pregnancy loss is

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Speaker 2: something that will be with you forever. So if you're

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Speaker 2: an old, if your grandma and your granddaughter has a miscarriage,

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Speaker 2: you'll say to her, miscarriage too, So you'll it will

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Speaker 2: be with you your whole life, but it won't hurt, yeah,

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Speaker 2: for very long. People are extremely resilient.

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Speaker 1: Yeah, and those that perhaps do need help, like it

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Speaker 1: will be a trigger where they need to sort of

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Speaker 1: seek help from a psychologist or you know.

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Speaker 2: Yeah, so a certain number of people that might be

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Speaker 2: the mental health straw that you know, it goes to

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Speaker 2: bit too far. And of course we're talking about people

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Speaker 2: with isolated first trumes to pregnancy loss. If you've got

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Speaker 2: recurrent pregnancy loss, that's a different scenario and it's very sad.

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Speaker 2: It's difficult to treat. But when people have a first trime,

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Speaker 2: mister miscarriage, they most people think that they're going to

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Speaker 2: be that person that it's going to keep on happening

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Speaker 2: and they'll never have a baby, And of course that's

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Speaker 2: not true for most people. Most people get pridden again

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Speaker 2: a few months later and they're fine. Yeah, So if

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Speaker 2: you've had about three miscarriages in a row, or you've

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Speaker 2: got miscarriage that are miscarriages that are suspicious, like they

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Speaker 2: happen really late, then we have to start investigating those

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Speaker 2: people and treating those people. But for most people that

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Speaker 2: doesn't need investigational treatment. It's they're not recurrent miscarriers. It's

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Speaker 2: an isolated thing, all right.

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Speaker 1: So someone's experienced a bleed in pregnancy, every single bleed

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Speaker 1: needs to be investigated. Is there anything that also happens

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Speaker 1: once you have a bleed in terms of their blood grouping.

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Speaker 2: Or Yeah, So blood group's relevant at this point, So

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Speaker 2: that if a woman's a negative blood group and has

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Speaker 2: some bleeds in pregnancy, then each one of those needs

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Speaker 2: to be looked at. That's a part of an issue

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Speaker 2: called recis disease, which we'll cover another day. But sometimes

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Speaker 2: a bleeding pregnancy is of a sufficient volume that we

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Speaker 2: need to treat the woman with some stuff called anti

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Speaker 2: d which will neutralize any positive blood cells which might

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Speaker 2: have escaped from a miscarriage into the mother's system.

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Speaker 1: I'm very for me with having my anti D shot

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Speaker 1: a recess negative. So you know, many anti D shots

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Speaker 1: along the sixteen years of having babies. It sounds like

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Speaker 1: I've got a lot, but there's only four in there,

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Speaker 1: all right. So a woman's had a bleed, what's the

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Speaker 1: next step?

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Speaker 2: I think the next step is for her to be

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Speaker 2: assessed by her doctor, for an ultrasound to be done

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Speaker 2: to look at the wellness of the pregnancy, and if

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Speaker 2: she's a negative group, for that to be taken into

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Speaker 2: consideration as well.

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Speaker 1: And there's a pregnancy, it's all going well. She goes

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Speaker 1: home and she just carries on, yeah, her life. But

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Speaker 1: the doctor thinks that she's had a miscarriage. So what

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Speaker 1: are the next steps?

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Speaker 2: Okay, So if we know it's a miscarriage, and we

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Speaker 2: know that for sure, then there are a few different possibilities.

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Speaker 2: It may be that the pregnancy ends by itself and

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Speaker 2: comes out by itself, and that can take time, but

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Speaker 2: it's certainly a nature's way of just emptying the uterus,

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Speaker 2: and some people are happy to wait for that to happen.

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Speaker 2: There are other situations where the bleeding might be very

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Speaker 2: heavy or painful, or the miscarriages happened a bit later

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Speaker 2: in the first trimester and there's a lot of material

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Speaker 2: from the pregnancy to come out, and in that situation

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Speaker 2: a curete can be a better thing to do. A

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Speaker 2: little operation to train the contents of the uterus using.

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Speaker 1: Suction, and someone's under general anesthetic.

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Speaker 2: Under a general anesthetic, yeah yeah, And which of those

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Speaker 2: is appropriate is a matterphor discussion with the dog based

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Speaker 2: on the clinical scenario and how unwell the woman is

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Speaker 2: and and what her preferences are.

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Speaker 1: Well. Everyone, I know that this has been a very

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Speaker 1: heavy topic. It's normal to feel anxious listening to issues

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Speaker 1: around early pregnancy and feeling like, well, what if this

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Speaker 1: happens to me? But if you feel like this anxiety

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Speaker 1: is really causing a change to your daily life and

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Speaker 1: impacting on how happy you feel during your daily life,

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Speaker 1: then I think it's time for you to seek some

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Speaker 1: more help. And first stop is probably the Perinatal Anxiety

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Speaker 1: and Depression Australia website. It's Panda dot org dot ayu

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Speaker 1: and they've got a really great mental health checklist and

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Speaker 1: you can do this checklist just to see whether it's

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Speaker 1: time for you to seek some help. All right, everyone,

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Speaker 1: thank you so much for tuning in to our podcast.

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Speaker 1: We love putting them together for you. If you've really

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Speaker 1: enjoyed this episode or any other episode, please share it

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Speaker 1: with a friend who's either pregnant or thinking of being pregnant.

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Speaker 1: That's how the message gets spread, and that's how more

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Speaker 1: people can be educated, just like you. So well done

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Speaker 1: for being informed during your pregnancy.

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Speaker 2: Thanks for listening, everybody.

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Speaker 1: Thanks everybody. Bye for now. I just need to remind

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Speaker 1: you that this podcast is for informational purposes only. We

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Speaker 1: share lots of medical insights and experience, but everything we

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Speaker 1: talk about is general in nature and may not apply

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Speaker 1: to your specific situation. Please always consult with your own

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Speaker 1: healthcare provider for your individual medical advice. When you grow

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Speaker 1: your baby,