When a woman has a positive pregnancy test, she may wish to be reassured that the pregnancy is developing normally in the early stages. This can be particularly important for couples who have experienced a previous miscarriage. The best time to have a viability scan (if there is no pain or bleeding) is at around 7 weeks gestation (that is 7 weeks from the time the last period started). If there is pain or bleeding we would suggest we perform a scan earlier.

Bleeding in early pregnancy is common and unfortunately in up to 50% of such cases, this may be a sign of miscarriage or an ectopic pregnancy. We recommend an ultrasound scan for any woman who has bleeding in early pregnancy (up to 20 weeks). We offer this and also an examination of the cervix to see if there is any other cause for the bleeding.

We are able to perform dating scans for women in whom the gestational age of the pregnancy is uncertain. This may be because you cannot remember when your last period started, you have irregular periods or because you have recently stopped the pill or stopped breastfeeding. A dating scan allows us to check the early pregnancy development and confirm when the important 11-14 week (nuchal translucency) scan should be performed.

Pain in early pregnancy may be due to a simple cause such as constipation or pain from the ovulation site of the ovary. Rarely however the pain is because the pregnancy is lodged in the tube (an ectopic pregnancy). This occurs in about 2% of all pregnancies and is potentially dangerous, so any woman with abdominal pain in pregnancy should have an ultrasound scan to ensure that the pregnancy is correctly located in the womb (uterus). We perform early pregnancy scans and would see women with pain urgently.

Miscarriage is the term used for the loss of a baby at any time in the first half of pregnancy. It is most common in the first few weeks, becoming much rarer after three months. Sometimes the pregnancy will be lost from the womb and the woman will experience heavy bleeding and pain. In other cases the pregnancy dies but the body does not recognise this and the pregnancy itself remains in the womb (a ‘missed miscarriage’). The only way to determine whether a miscarriage has occurred is by performing an ultrasound scan. We perform urgent ultrasound scans in women with suspected miscarriage. We will also counsel you about the causes and how it should be managed. If a surgical procedure is needed to empty the womb, we will arrange to perform this within the hospital.

An ectopic pregnancy is a pregnancy which has lodged in the fallopian tube (which connects the ovary to the womb) rather than in the womb itself. It is common (occurring in 2% of all pregnancies). Because the tube cannot grow as the pregnancy expands, internal bleeding sometimes occurs if the tube ruptures. This can be dangerous.

Women may not wish to wait until the routine 11-14 week scan to be reassured that the pregnancy is developing normally in the early stages. This may be because they have had a previous bad experience (such as a miscarriage or an ectopic pregnancy) or because of other anxieties. A reassurance scan is usually best carried out at around 7 weeks. In women with a high risk of ectopic pregnancy, then the scan should be at around 5 weeks to confirm the location of the pregnancy is in the womb (uterus) and not the fallopian tube (ectopic pregnancy).

If you have a positive pregnancy test but we have been unable to see the pregnancy with an ultrasound scan it is called a ‘Pregnancy of Unknown Location’ (PUL).

In this situation there are three possible scenarios:

• The pregnancy is too early to see on scan. Commercially available pregnancy testing kits are now extremely sensitive and can sometimes detect the pregnancy hormone just 9 days after conception (usually 23 days from your last period). However a pregnancy may not be seen on ultrasound until approximately 3 weeks after conception (usually 5 weeks from your period). This results in women attending with a pregnancy that is too early for us to see.
• An early miscarriage has occurred. If you have had bleeding it could be that an early miscarriage has occurred so that the pregnancy is no longer seen within the uterus (womb) because it has already been passed.
• The pregnancy is outside the uterus (womb), most commonly in the fallopian tube. This is called an ectopic pregnancy. It is the least likely possibility but if ignored an ectopic pregnancy is potentially life threatening. We need to treat all women with a PUL as if they might have an ectopic pregnancy until we confirm a miscarriage with blood tests, or confirm a pregnancy seen developing within the womb.

What happens next? To help us find out where the pregnancy is developing we need to look at the pregnancy hormone (hCG) level and how much it increases over a 48-hour period and then usually what the level is after seven days. You will need to have two or three blood tests and usually a second scan 7 days after the first. It is very important that we have all of these blood samples to compare with each other. One sample will not give us enough information.

It is common to want to know all is well before starting to try for a family. We are able to see you to give general advice about fertility, conception and lifestyle. We can discuss any concerns you may have and, if indicated, perform some baseline tests and an ultrasound scan.