20.1  What is early pregnancy bleeding?

Bleeding before 28 weeks of pregnancy is considered as early pregnancy bleeding. If it occurs after 28 weeks it is referred to as late pregnancy bleeding. This cut-off-point of 28 weeks is based on the chance of survival if the baby is born before the expected date at 28 weeks. Survival before 28 weeks is very minimal in countries like Ethiopia where there is a shortage of intensive care facilities for premature babies. Nowadays some countries have brought the cut off point to 20 weeks because of the increased chance of survival due to the improved care and technology their health system provides.

The main cause of early pregnancy bleeding is abortion, the ending of a pregnancy early with the loss of the fetus. Two other common causes are ectopic pregnancy (when the fetus implants and grows outside the uterus), and molar pregnancy (when a tumour grows in the uterus instead of a fetus). We will refer to both of these problems near the end of this study session, but our main focus will be on abortion.