Question: Hi Doctor,

This is regarding my wife, who is currently 8 weeks pregnant. This is a second pregnancy and the last one was a miscarriage (refer to history below).

The ultrasound was conducted 9 days agao (TVS) and reports are normal. She is on bed rest/leave and all precautions being taken.

Since today morning, she has been complaining of some dark brownish blood discharge (light to mild spotting) - with no pain / cramps as such.

We are concerned, and apprehensive more so because of her last year's miscarriage. She is completely normal otherwise except for nausea and morning sickness, acidity and general lethargy. Our Gynaec has mentioned that it is normal in first trimester to experience nausea.

However, should we be concerned about this spotting/dark brown blood discharge ? Last year just before the miscarriage - she had been bleeding (clots). Then suddenly she started leaking some more fluid and within 2-3 days - apparently the entire amniotic fluid got leaked and fetus expired. We had to go for MTP subsequently.

Presently, the discharge has started today - and its not foul smelling or heavy ... There is no pain as well....

We understand some bit of discharge/spotting is supposed to be normal in first trimester. But how to distinguish properly between normal discharge and serious condition ? We dont want to be paranoid because of last year's miscarriage ; at the same time, we want to make sure that adequate care/treatment is being provided for...

Request you to kindly respond with your expert opinion and suggestions.

Thanks and Regards,
XXXXXXX

Dear Doctor XXXXXXX

Thanks a lot for your reply and assurance.

We have gone ahead and done the Ultrasound tests a couple of days ago. I am summarising the findings of the Ultrasound report (19th Feb)...

"A single well formed gestation sac is seen normal in location, shape and with good peripheral echogenicity.
Small retroplacental collection seen near XXXXXXX os measuring - 2.2 x 1.6 x 1.6 cm (3.1 cc).
Single fetal node and yolk sac seen within.
Fetal heart appreciated and is 164 bpm
CRL measures 2.02 cm - corresponds to 8 weeks & 3 days
Yolk sac measures 5.2 mm
Cervix is normal , 5.2 cm XXXXXXX os is closed
Both ovaries are normal in size and echotexture.
Impression : Single live intra uterine embryo of 8 weeks 3 days gestation with small retro-placental collection. "

Treatment plan by Gynaec : (some medicines - i may misspell due to legibility issues with the handwriting on prescription)
1. Injection HUCOG / OVIalae - 5000 IU - 1/m Biweekly
2. Injection Sustain 200 mg. - 100 mg 1/m daily
3. Tablet : Duphaston 10 mg - 2 tablets daily
4. Folic Acid tablets - 5 mg ( 2 tablets daily)
5. Bed rest for 1 week
6. Repeat US scan after a week.

It seems like there is a small retroplacental collection of 3CC which is causing the bleeding; but my gynaec was unable to pin point the cause. Advice provided is complete bed rest and progesterone injections (sustain 200). We are following the advice. While the spotting/bleeding is not heavy at all... yet there has been occasional mild spotting in last couple of days (lighter than the day when I posted the query - when she had first reported spotting). However it has not stopped completely. Doctor has adviced a repeat scan after a week. However there is no abdominal pain/cramping at this point of time.

Her nausea and morning sickness continues to persist as well. Currently she is in the 9th week.

We are based in Gurgaon and consulting Dr. XXXXXXX XXXXXXX - in XXXXXXX Hospital Gurgaon.

Request you to please advice us whether the treatment plan is adequate and if anything else needs to be done.

As mentioned earlier, last year's miscarriage was triggered initially by similar bleeding - which then led to sudden loss of amniotic fluid and fetal demise. We are hoping for the best this time, but at the same time are worried as well.

Would appreciate any advice you can provide.

Thanks and Regards,
XXXXXXX