Is it common, causes, and seeing a doctor

There are various reasons a person may experience spotting in early pregnancy. For instance, spotting at 6 weeks may be from hormonal changes.

People may experience light bleeding during early pregnancy, known as spotting. This is a common occurrence but can be a sign of a more serious problem.

In this article, we discuss the common causes of spotting, what it may look like, and when to contact a doctor.

About a quarter of pregnant people experience bleeding during the first trimester. Although bleeding is a possible sign of early pregnancy loss, it does not mean this will happen.

Several other conditions and factors, including normal hormonal shifts, may cause spotting in early pregnancy.

The most common causes of spotting in early pregnancy include:

Subchorionic hematoma

A subchorionic hematoma happens when blood builds up near the chorion, the fetal membrane next to the placenta. The bleeding may also appear between the uterus and the placenta.

Some people may also refer to this as a subchorionic hemorrhage.

Subchorionic hematoma is the most common cause of bleeding in the first trimester of pregnancy, accounting for around 11% of cases.

A subchorionic hematoma is not a pregnancy loss. Many pregnant people with this type of bleeding have no further complications during their pregnancy.

People who experience a subchronic hematoma are at a higher risk of early pregnancy loss.

Ectopic pregnancy

In an ectopic pregnancy, a fertilized egg implants outside the uterus, often in the fallopian tubes. A person may still have pregnancy symptoms or get a positive pregnancy test.

The pregnancy, however, cannot survive. It can rupture and cause life threatening bleeding or a dangerous infection if it continues to grow.

An ectopic pregnancy can cause spotting as the pregnancy grows. In the case of a rupture, internal bleeding may get progressively heavier over several hours.

Cervical irritation

The cervix, the doughnut-shaped entry to the uterus, increases its blood supply during pregnancy. This means it is more likely to bleed from irritation, such as after sex or a pelvic exam. Light spotting after any form of vaginal penetration is a possible sign of cervical bleeding.

Cervical bleeding during pregnancy is typically not a cause for concern. However, a serious injury to the cervix, such as an assault or trauma, might cause more severe cervical bleeding.

These injuries can cause infections and other serious complications. It is important to contact a doctor following any traumatic injury to the cervix or vagina.

Learn more about changes to the cervix in early pregnancy here.

Pregnancy loss

Vaginal bleeding is the most common sign of pregnancy loss. The medical term for pregnancy loss in the first 23 weeks is miscarriage.

However, around half of people that experience light bleeding during early pregnancy do not lose their pregnancy.

Any pregnant person who has concerns about their pregnancy should speak with a doctor about risk factors and how to minimize them.

Hormonal shifts

Around week 6–8 of pregnancy, a luteal-placental shift happens. This is when the placenta develops enough to produce hormones that sustain the pregnancy. Before this change, the corpus luteum — a group of cells that forms during ovulation — produces pregnancy hormones.

This hormonal change sometimes triggers a temporary drop in the hormone progesterone. This shift may cause spotting or even bleeding as heavy as a period. As long as the placenta begins producing enough progesterone, the pregnancy can safely continue, and a pregnancy loss will not occur.

Implantation bleeding

Implantation happens when a fertilized egg embeds in the lining of the uterus. This marks the beginning of pregnancy. Some people notice spotting shortly after implantation. However, the body does not begin producing the pregnancy hormone human chorionic gonadotropin (hCG) until after implantation.

A person is not pregnant until after implantation, and a pregnancy test cannot usually detect pregnancy until several days after implantation. So, bleeding that appears after a person already knows they are pregnant is not implantation bleeding.

Implantation bleeding is usually brown. Some people may mistake the bleeding for their monthly period because it usually occurs around the time a person expects their period.

The flow of implantation bleeding is often lighter and shorter than a period, so people who experience unusual bleeding after having sex should consider the possibility of pregnancy.

A doctor or other healthcare professional may conduct or order numerous tests to diagnose bleeding.

Ultrasound

An ultrasound can diagnose a subchorionic hematoma. It can also tell a healthcare professional the location of the pregnancy, helping in the detection of an ectopic pregnancy.

Doctors can also use ultrasound scans to assess the viability of the pregnancy. If the embryo is growing correctly, and there is a sufficiently strong heartbeat, this suggests that the pregnancy will continue and the risk of pregnancy loss is low.

An ultrasound can also examine other pelvic organs to check for causes of bleeding. For example, an ovarian cyst may cause bleeding.

Blood tests

Blood tests can measure levels of the pregnancy hormone hCG. Low hCG may suggest that a pregnancy is not developing correctly or is in its early stages.

Some healthcare providers also check progesterone levels. Low progesterone may cause temporary bleeding, while very low progesterone may be a sign of an abnormal pregnancy.

While many people who experience bleeding have healthy pregnancies, it is important never to treat bleeding as usual.

Bleeding can be a critical symptom of several pregnancy-related symptoms, and prompt treatment for conditions such as ectopic pregnancy can save lives.

People should speak with a doctor about any bleeding early in pregnancy. While the bleeding may be harmless, it is impossible to diagnose its cause without blood work, an ultrasound, or other diagnostic tests.

Bleeding from a ruptured ectopic pregnancy can endanger the life of the pregnancy carrier. While many pregnancy losses pass on their own, some require treatment to prevent excessive bleeding and infection.

If a person experiences light bleeding at any time, they should contact a midwife, doctor, or another healthcare professional.

A pregnant person should also visit an emergency room if:

• they develop a fever
• bleeding gets heavier over several hours
• bleeding is heavy, similar to a period
• there are large clots in the blood
• they have cramps
• they have severe pain in the abdomen
• they feel dizzy or lightheaded

Prompt medical care can be lifesaving. Even when there is no serious problem, the right care can offer peace of mind.

If a pregnant person experiencing spotting has Rhesus-negative blood, a doctor may prescribe RhoGAM. This treatment can help prevent a condition known as erythroblastosis fetalis.

Many people panic when they bleed during pregnancy, especially if they have a previous history of pregnancy loss. Seeking prompt care is the fastest way to ease anxiety and get clear answers.

It is not advisable for people to try to self-diagnose bleeding or assume that bleeding means a pregnancy loss. Quick tests can usually diagnose the cause, and prompt treatment can prevent possible complications.

Bleeding During Pregnancy, What’s Normal?

Whether you’re early on in your pregnancy or about to pop, vaginal bleeding of any kind can be very scary and worrisome. Is this normal spotting or should you be concerned about your unborn baby?

In many cases, bleeding during pregnancy is normal. Where you are in your pregnancy and the severity of bleeding – whether light spotting or heavy bleeding – provide clues as to whether what you’re experiencing is normal or cause for concern.

Is there a difference between spotting and bleeding?

Spotting is light bleeding—the type of bleeding that wouldn’t cover a panty liner. Whereas bleeding is a flow of blood that’s greater than a drop here and there. It’s heavier in nature and would require a liner or pad to keep the blood from soaking through your underwear.

You should always let your provider know if you’re experiencing any type of spotting or bleeding, but the timing of when to seek help is key.

When should I seek help for vaginal bleeding during pregnancy?

If you notice pink, red or dark brown ‘spots’ smaller than a dime on undergarments or when you wipe, you can generally wait until your health care provider’s office opens to call and schedule an appointment.

“However, bleeding that soaks through a pad within an hour, and continues, requires urgent evaluation in the emergency room during the first trimester and early second trimester. Patients in mid-second trimester and beyond should go directly to the triage room in labor and delivery,” said Celia Valenzuela, MD, an OBGYN at Banner Health in Tucson, AZ. “Bleeding that is similar to your period in the third or mid to late second trimester always warrants evaluation. ”

It’s important to know your blood type as some blood types may require special medication. If your blood is Rh negative, you’ll likely need medicine called Rh immunoglobulin or RhoGAM. Your provider can guide you through the timing of this. Learn more about Rh factor.

[Call 911 if you’re also experiencing intense cramping, a fever of 100.4 or higher, dizziness or thick vaginal discharge along with heavy bleeding.]

While it’s natural to go to worst case scenario at the sight of blood, read on to learn the potential causes for bleeding during the first trimester, second trimester and third trimester.

What are the most common causes of bleeding in the first trimester?

While seeing blood in your underwear can be unnerving, it’s not uncommon during the first trimester. While estimates can vary, about 1 in 4 pregnant people experience bleeding during the first trimester.

One of the most common causes of bleeding in early pregnancy occurs in the first few weeks during implantation, when the fertilized egg implants on the uterine wall.

“During pregnancy, pregnancy hormones can alter a person’s cervix, making it more sensitive and more susceptible to bleeding when touched,” Dr. Valenzuela said. “It’s not uncommon then to notice spotting or light bleeding after sex, insertion of a speculum, collection of a cervical specimen for pap test or culture and cervical examination for dilation.”

Problems that can cause bleeding in early pregnancy can include:

• Pregnancy loss or miscarriage: Roughly half of people who experience spotting in early pregnancy do miscarry, however this means half of women who spot, do not.
• Ectopic pregnancy: Usually, an ectopic pregnancy happens when a fertilized egg implants outside of the uterus. Symptoms of an ectopic pregnancy may include spotting or light bleeding and pelvic or belly pain. This is rare in pregnancies but is considered a medical emergency. “The amount of bleeding that you may experience can vary, though generally it is light prior to diagnosis,” Dr. Valenzuela said. “After an ectopic pregnancy is treated, you may have heavier bleeding as hormone levels decrease.”
• Molar pregnancy: A molar pregnancy is rare but occurs when abnormal tissue grows inside the uterus, instead of an embryo. You may think you’re pregnant, but an ultrasound shows no fetal heart rate. “Frequently, molar pregnancies are discovered during an ultrasound during the first trimester before bleeding has started,” Dr. Valenzuela said.
• Cervical or vaginal infections: Any infection of the cervix, vagina or a sexually transmitted infection like chlamydia, gonorrhea or herpes can cause bleeding.
• Cervical polyps: A harmless growth on the cervix that can result in bleeding during pregnancy.

“Many people frequently worry about miscarriage when they experience bleeding in the first trimester, and as a provider, we worry about this as well,” Dr. Valenzuela said. “Call your health care provider, so they can do the appropriate blood or ultrasound tests to identify the cause. ”

What are the causes for vaginal bleeding later in pregnancy?

Like the first trimester, light bleeding or spotting during your second or third trimester may occur after sex or a cervical exam. It can also be due to a “bloody show,” a sign that labor is starting.

Problems that can occur later in pregnancy can be caused by placental abnormalities, such as placental abruptions or placenta previa.

“Placenta abruptions occur when the placenta separates partially from the uterine wall often resulting in very heavy bleeding,” Dr. Valenzuela said. “Placental previas occur when the placenta is placed over the opening of the cervix. Both require timely medical care.”

Bottom line

Not all spotting and bleeding are a cause for concern during pregnancy, but it’s best to get evaluated by your health care provider.

If you’re experiencing abdominal pain, cramping, unusual vaginal discharge, contractions, fever or soreness in the uterus, seek emergency care. These symptoms could be a sign of a serious problem or may even signal preterm labor.

Also read:

• Prenatal Screenings and Tests, What to Expect Every Trimester
• Is a Headache During Pregnancy Something to Worry About?
• Expect the Unexpected: How Your Body Changes During Pregnancy

Women’s Health
Gynecology
Pregnancy

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Bleeding and formation of retrochorial hematomas in the first trimester of pregnancy are clinical forms of miscarriage and in 10-15% of cases complicate the course of pregnancy in women with recurrent miscarriage. In half of these cases, these clinical manifestations are recurrent and extend not only to the first trimester (up to 12 weeks), but also to the second (up to 16-18 weeks). However, at such terms of gestation, the placenta has already been formed, and hematomas are retroplacental in nature and are a manifestation of premature placental abruption. It is the recurrent course of retrochorial hematoma that presents the greatest difficulty in management tactics.

During 2015, a study was conducted in the third gynecological department of the KSBUZ “KMKB No. 4” on the rational use of tranexamic acid in the event of bleeding during pregnancy.

The purpose of the study was to evaluate the effectiveness of tranexam in this pathology.

Due to the high prevalence of miscarriage today deserves special attention. For many years, this complication has remained an urgent problem in obstetrics, despite the progress of science in general. The desired pregnancy in 15-20% of cases ends with early spontaneous termination, and the embryonic period accounts for up to 75% of all reproductive losses associated with miscarriage. It is difficult to overestimate the medical and social relevance of the problem of miscarriage in modern conditions of declining birth rates and increasing mortality. One of the signs of early pregnancy termination is retrochorial hematoma, due to partial rejection of the fetal egg from the chorion, the precursor of the placenta.

Retrochorial hematoma is a formation that occurs when the fetal egg is torn away from the chorion. This forms a cavity filled with clotted blood, which is the most retrochorial hematoma.

Depending on the duration of pregnancy, two types of hematoma are distinguished:

Retrochorial (with detachment of the ovum from the chorion). This type of hematoma can occur up to 16 weeks;
Retroplacental (with detachment of the fetal egg from the placenta). The placenta finally completes its formation by the 16th week of pregnancy. When a hematoma occurs, they speak of premature detachment of a normally located placenta.

Severity classification:

1) Mild. In most cases, a mild hematoma is an incidental finding on ultrasound, the woman does not present any complaints;

2) Average degree. The pregnant woman is disturbed by pulling pains in the lower abdomen, the appearance of bloody discharge from the genital tract is possible;

3) Severe. There are strong cramping pains in the lower abdomen, intense bleeding, a drop in blood pressure. The general condition of the woman is significantly deteriorating, loss of consciousness is possible.

There are many reasons that can cause such a complication:

1) Disorders associated with diseases of the endocrine system.

2) Great physical activity. That is why pregnant women are not recommended to lift weights, as this can lead to complications during pregnancy and fetal malformations.

3) Infectious and inflammatory processes in the urinary organs. Any signs of an infectious disease should be cause for immediate treatment.

4) Harmful work associated with constant noise or vibration.

5) Autoimmune diseases. These are deviations in which the immune system produces antibodies that react not to some foreign elements and microorganisms, but to healthy cells of their own body.

6) Blood coagulation disorders.

7) Chronic endometritis.

8) Frequent stress.

9) Injuries.

10) Tumors of the uterus.

11) Severe form of toxicosis.

12) Bad habits of a woman.

13) Malformations of the child

14) Congenital malformations of the uterus.

15) Genital infantilism. This term refers to a delay in sexual development, in which an adult woman has a number of sexual characteristics that are more characteristic of a child or adolescent.

It is almost impossible to prevent the occurrence of retrochorial hematoma, as well as to determine the exact cause of its formation.

Fig 1. Retrochorial hematoma

In the 3rd gynecological department, the complex of treatment includes gestagenotherapy (utrogestan, prajisan, duphaston, oily solution of pogesterone) in a therapeutic dosage, hemostatic therapy (dicinone, tranexamic acid). Hemostatic drugs should be prescribed according to indications. Tranecamic acid is indicated for:

1) Threat of early pregnancy termination (chorionic detachment, hematoma)

2) Low position of the placenta and bleeding in the first and second trimesters of pregnancy

3) Pregnancy with malformations of the uterus (double and bicornuate uterus, intrauterine septum – bleeding in the first and second trimesters of pregnancy)

4) Transmenopausal hematomas in the second trimester of pregnancy

5) Marginal abruption of a normally located placenta in the second trimester of pregnancy

Tranexam is an antifibrinolytic agent that specifically inhibits the activation of profibrinolysin (plasminogen) and its conversion to fibrinolysin (plasmin). It has a local and systemic hemostatic effect in bleeding associated with an increase in fibrinolysis (platelet pathology, menorrhagia), as well as anti-inflammatory, anti-allergic, anti-infectious and antitumor effects by suppressing the formation of kinins and other active peptides involved in allergic and inflammatory reactions.

Fig. 2. The mechanism of action of tranexamic acid

When analyzing the studied case histories of patients, negative experience has accumulated in the appointment of tranexam with scanty dark bloody discharge from the genital tract. In the presence of acute bleeding (scarlet spotting), the use of the drug has a positive result. In the case of bloody discharge from the genital tract associated with the emptying of the “old” retrochorial hematoma, there was a reverse trend towards an increase in the volume of the hematoma. In this case, tranexam is not shown. With scant brown discharge from the genital tract, it can be regarded in the early stages of pregnancy as nidation or migration of the fetal egg into the uterine cavity. In the case of the appointment of the drug dicynone, there is a positive trend. From this we can conclude: the point of application of tranexamic acid is acute bleeding during pregnancy, which, according to the doctor, will require immediate action to stop the bleeding.

For bleeding during pregnancy, we use the following regimen for prescribing tranexam — 250-500 mg 3 times a day until the bleeding stops completely. With local fibrinolysis, therapy begins with parenteral (in / in) administration of Tranexam®, followed by the transition to oral administration of 250-500 mg 2-3 times a day. The average duration of the course of treatment is 7 days. Side effects of the use of the drug tranexam in the department were not observed.

A retrospective analysis of 30 case histories of patients of the 3rd gynecological department who received tranexam was carried out. At 19cases, the appointment of tranexam for acute bleeding, not associated with the volume of retrochorial hematoma – a positive trend. In 11 cases, the appointment of the drug for scanty bloody discharge from the genital tract in patients admitted with a clinic of previously occurring retrochorial hematomas, emptied against the background of tranexam, the volume of the hematoma increases by 2-3 times, after a while in the absence of any manifestations of ongoing uterine bleeding. In the future, such patients undergo antibiotic therapy to prevent ascending infection, enzyme therapy at the outpatient stage.

References

1) Torchinov A. M., Umakhanova M. M., Doronin G. L., Ron M. G. Short-term pregnancy and retrochorial hematoma: diagnosis, treatment and prognosis at the present stage of development of obstetrics (literature review ) // Young scientist. – 2013. – No. 4. — S. 659-662.

2) Milovanova A.P., Serova O.F. 2011. Causes and differentiated treatment of early miscarriage.

3) Sidelnikova V.M., Sukhikh G.T. 2010. Miscarriage.

4) Strizhakova A.N., Davydova A.I., Ignatko I. V., Belotserkovtseva L.D. 2011. Miscarriage.

5) Korneeva I.E., Serova O.F. 2013. The threat of termination of pregnancy at various gestational ages. Tactics and strategy of modern therapy.

6) Makatsaria A.D. 2015. High Risk Pregnancy.

7) Podzlkova N.M., Skvortsova M.Yu. 2010. Miscarriage

Mashina I.N., Elizariev E.A., Rustamova E.Kh.

3rd gynecological department of KMBUZ “KMKB No. 4”

Threatened miscarriage in early pregnancy – symptoms and treatment

When a woman is pregnant, the safety of the unborn child becomes the number one priority, so she must be aware of early signs and symptoms miscarriage. Since the risk of miscarriage in early pregnancy is especially high, up to 12/13 weeks, you need to carefully monitor the health of the expectant mother. It is believed that in the first week after conception, up to 50% of fertilized eggs die, when a woman is not yet aware of the changes taking place in her body.

At this time, dangerous symptoms that indicate a threat of pregnancy are so implicitly expressed that they can be ignored. Later, after the conception becomes known, and the test confirms that fertilization has occurred, at least 10-20% of pregnancies end tragically.

According to statistics, from 1 to 4% of women have two miscarriages in the early stages in a row. Even more rarely, threats of miscarriage lead to three or more miscarriages. This condition is referred to as habitual miscarriage. A synonym for the word “miscarriage” is “spontaneous abortion”, when it means that the body itself gets rid of the embryo.

Signs of a threatened miscarriage – warning signs

Signs of a threatened miscarriage in early pregnancy include the following conditions: The blood may have a brown or brownish tint, or it may be bright scarlet;

Termination of signs of pregnancy , when the nausea, dizziness, sensitivity of the chest, reaction to smells, inherent in a woman before, suddenly disappear.

If you are in danger of having a miscarriage and some of the symptoms listed above have you on your guard, don’t waste your time. Contact your doctor immediately who is monitoring your pregnancy. The specialist will examine you, send you for an ultrasound, and then diagnose whether there is a threat and what treatment will be effective. Or he will say that fears are in vain.

Types of early miscarriage

If we talked about the signs of early pregnancy termination, it is necessary to understand how doctors classify the condition. The typology is based on the following groups:

1. Threatened miscarriage – slight bleeding in the first trimester. About 1/3 of women will bleed during this period, and only half of them are diagnosed with spontaneous abortion;
2. Complete miscarriage – symptoms of a threatened early miscarriage are confirmed by a medical examination, which shows that a miscarriage has occurred. In this case, all embryonic tissues come out of the uterus. Subsequently, no additional treatment or observation by specialists is required;
3. Incomplete miscarriage – the threat of miscarriage in early pregnancy is confirmed. The embryo dies, but its tissues do not completely leave the uterus, which threatens to provoke an infection and can cause sepsis. Some women may need emergency surgery due to heavy bleeding. Medications may be used to provoke the uterus into contractions and ejection of fetal debris. In some cases, waiting tactics are acceptable without taking any action;
4. Anembryony is a condition in which the symptoms of a threatened miscarriage may not be observed in the early stages. Fertilization of the egg occurs, its implantation in the wall of the uterus, but there is no formation of the fetus. In some cases, even a gestational sac is formed;
5. Missed miscarriage – in case of a missed pregnancy, when it stops developing, the embryonic tissue does not leave the uterus for at least 4 weeks. One of the main symptoms of a miscarriage in the early stages is absent – severe bleeding. There may be slight spotting;
6. Septic miscarriage – accompanied by infection in the uterine cavity. A serious illness that requires immediate treatment to prevent the death of the failed mother. Early signs of a threatened septic miscarriage are fever, abdominal pain, and foul-smelling bleeding. It is important to start injecting antibiotics as soon as possible and remove the foreign contents of the uterus.

Many women are interested in the natural question of what to do with the threat of miscarriage in early pregnancy and how to prevent a dangerous condition. We will talk about this a little later, first we will designate the factors provocateurs of spontaneous abortion.

Provocateurs of threatened miscarriage in early pregnancy

Among the factors that future parents can influence are smoking, alcohol, drugs, excessive physical labor of the mother during pregnancy. This can be corrected by minimizing their effect. However, there are reasons that are difficult to influence:

• Genetics – about half of spontaneous abortions are due to genetic abnormalities that are incompatible with the life of the fetus;
• Maternal diseases – even a banal temperature increase to extreme values ​​can harm the developing embryo, but there are more dangerous infections – measles, rubella, cytomegalovirus and others;
• Hormonal imbalance – women with irregular periods have a higher risk of threatened miscarriage in early pregnancy than those who have regular periods;
• Placental problems – disorders of the blood supply to the placenta, which provokes a lack of nutrition of the embryo;
• Early dilatation of the cervix , fibroids, unusual organ shape that prevents the fetus from developing;
• Mechanical injuries – may cause spontaneous abortion in the early stages, threatened miscarriage at 20 weeks and beyond.

One of the common threats of miscarriage in early pregnancy is an ectopic pregnancy, when the embryo develops in one of the fallopian tubes or elsewhere – outside the uterus. The age of the mother is of no small importance:

There are other reasons why there is a single miscarriage and two miscarriages in the early stages in a row. Finding out the reasons is better to entrust to specialists, if necessary, visit a genetics consultation, pass the necessary tests and undergo examinations. This is especially true for women who have had two miscarriages in the early stages. However, this is not a reason to put a sentence on a woman’s ability to bear children. The chance to endure and give birth to a healthy baby is great even after three unsuccessful pregnancies.

What to do if there is a threat of miscarriage – getting ready for a new conception

If you have had two early miscarriages, but you are striving for the birth of a healthy baby, it is important to carefully plan your pregnancy, avoid stress, overload, hypothermia and other negative factors. You do not need to be alone with your misfortune, it is important to find a specialist you will trust, who knows what to do with a threatened miscarriage and how to reduce the risks when planning a new conception.

One of the important points is to find the root cause of what is happening. It is important to remember the symptoms of a threatened miscarriage, when they occurred, whether they were preceded by some events that could play a decisive role. On the recommendation of a doctor, undergo special examinations:

1. Blood tests – deciphering the results in the laboratory will help to find hormonal problems or identify negative features of the immune system;

2. Chromosome tests – to detect signs of a threatened miscarriage in the early stages, it is enough for partners to donate blood, in which chromosomal abnormalities can be detected.

3. Ideally, fetal tissue should be submitted for analysis, which will also be rigorously examined.

To find out how to prevent the threat of miscarriage in the early stages, resulting from the pathology of the uterus, you need to go through:

• Ultrasound – thanks to the action of high-frequency sound waves, an image is formed on a computer monitor, which accurately reflects the features of the studied areas, tissues, organs. The specialist conducts an examination by external scanning and examination through the vagina. Thanks to the ultrasound method, fibroids and other anomalies can be detected;
• Hysteroscopy – the introduction of a hysteroscope through the cervix into the internal cavity of the organ. Thanks to special illumination, the doctor clearly sees structural transformations in tissues, which allows him to diagnose the problem and prescribe effective treatment to prevent miscarriage in the early stages;
• Hysterosalpingography and sonohysterography – a contrast agent is injected into the uterus through a catheter.