Early Pregnancy Loss: Signs, Symptoms, and Next Steps

Spontaneous abortion at 4 weeks of pregnancy?

Hello, doctor.
I have a few questions I would like to ask you: Background: It has been exactly four weeks since the first day of my last menstrual period, and two days before my expected period, I experienced intense abdominal movement around noon.
Five minutes later, I had severe abdominal pain, went to the bathroom, and experienced diarrhea followed by vomiting.
I felt numb and weak all over, my face was pale, and I was sweating coldly, almost fainting.
At this time, I continued to have severe abdominal cramps, which gradually eased after about half an hour to an hour.
After the pain subsided, I went to the bathroom and noticed some white discharge mixed with a little pink blood.
Concerned about pregnancy, I used a pregnancy test, and the result was negative (second urine, not morning urine).
There was no bleeding in between, and only in the evening did I notice a little brown blood, which turned into bright red blood by early the next morning.
1.
Given the above situation, is the second urine pregnancy test accurate?
2.
I have experienced one or two instances of severe uterine contractions accompanied by diarrhea and vomiting, but these occurred during my menstrual period rather than beforehand.
Could this mean that I was unaware of being pregnant and that external factors led to a miscarriage? Or could the severe abdominal shaking have caused the endometrium to shed prematurely?
3.
If it is a miscarriage, can a pregnancy test still show positive results within three days? Should I go to the hospital to check if everything has been expelled? How should I take care of myself afterward? Do I need to focus on nutrition or follow any rules like not washing my hair? Additionally, can I continue weight training (30 kg) and other exercises? (I am currently abroad and cannot seek immediate medical attention, and I am really anxious...) Thank you for your patience in addressing my concerns!

S, 20~29 year old female. Ask Date: 2019/12/01

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Four weeks after the first day of the last menstrual period, two days before the expected period, there was intense abdominal cramping around noon.
Five minutes later, there was severe abdominal pain, leading to a trip to the restroom where there was diarrhea followed by vomiting.
The individual experienced full-body numbness and weakness, pale complexion, and cold sweats, almost fainting.
During this time, the abdominal pain continued intensely for about half an hour to an hour before gradually easing.
After the pain subsided, there was a visit to the restroom where a small amount of white discharge mixed with a bit of pink blood was observed.
Due to concerns about pregnancy, a pregnancy test was conducted using a home pregnancy test kit, which returned a negative result (using the second urine sample, not first morning urine).
There was no bleeding during this period, and only a small amount of brown blood appeared in the evening, which turned to bright red blood by the early morning of the next day.
1.
Given the above situation, is the second urine pregnancy test accurate? Answer: Yes, it is accurate.
2.
There have been one or two previous instances of severe uterine contractions accompanied by diarrhea and vomiting, but these occurred during an ongoing menstrual period rather than beforehand.
Could this indicate an unknown pregnancy leading to a miscarriage due to external factors, or could the intense abdominal shaking have caused the endometrium to shed prematurely? Answer: It is likely menstruation.
3.
If it were a miscarriage, would a pregnancy test still show positive results within three days? Is it necessary to go to the hospital to check if everything has been expelled? What precautions and follow-up actions should be taken? Is there a need for dietary supplements or to follow rules such as not washing hair? Answer: It is not a miscarriage.

Reply Date: 2019/12/01

More Info

Understanding early pregnancy loss is crucial for anyone experiencing symptoms or concerns during the early stages of pregnancy. Based on your description, it seems you are facing a complex situation that involves potential pregnancy loss, and I will address your questions systematically.

1. Accuracy of Pregnancy Tests: The accuracy of a home pregnancy test can vary based on several factors, including the timing of the test and the concentration of hCG (human chorionic gonadotropin) in your urine. Since you tested in the afternoon and not with first-morning urine, it is possible that the test could yield a false negative, especially if the hormone levels are low. If you suspect you might be pregnant, it is advisable to retest with first-morning urine or consult a healthcare provider for a blood test, which is more sensitive and can detect lower levels of hCG.

2. Possibility of Miscarriage: The symptoms you described, including severe abdominal pain, nausea, and the presence of blood, could indicate a miscarriage, especially if you were unaware of a pregnancy. It is indeed possible for a woman to experience a miscarriage without realizing she was pregnant, particularly if the pregnancy is very early. The physical stress from vigorous activity or trauma can sometimes lead to complications, including miscarriage. However, it is also possible that the symptoms could be related to other conditions, such as a gastrointestinal issue or a menstrual irregularity.

3. Testing for Miscarriage: If a miscarriage has occurred, it is possible to still detect hCG in your system for a few days after the event, depending on how far along you were and how quickly your body metabolizes the hormone. If you continue to experience bleeding or have concerns about whether the miscarriage was complete, it is essential to seek medical attention. A healthcare provider can perform an ultrasound to check for retained tissue and ensure that your body is healing properly.

4. Post-Miscarriage Care: After a miscarriage, it is generally recommended to allow your body to recover. This includes monitoring for excessive bleeding, severe pain, or signs of infection (such as fever). While there are no strict rules about washing your hair or other daily activities, it is advisable to avoid heavy lifting or intense exercise until you have been cleared by a healthcare provider. If you are accustomed to weight training, you may need to modify your routine based on how you feel and any medical advice you receive.

5. Diet and Recovery: Maintaining a balanced diet is essential for recovery. Focus on nutrient-rich foods that support healing, such as fruits, vegetables, lean proteins, and whole grains. Staying hydrated is also important. While there are no specific dietary restrictions post-miscarriage, listening to your body and avoiding anything that causes discomfort is key.

6. Emotional Well-being: Experiencing a potential miscarriage can be emotionally taxing. It is important to seek support from friends, family, or professionals who can help you process your feelings. If you find yourself feeling overwhelmed, consider reaching out to a mental health professional who specializes in reproductive health.

In conclusion, while your symptoms are concerning and may indicate a miscarriage, it is essential to seek medical advice as soon as possible, especially since you are currently abroad and may not have immediate access to healthcare. Monitoring your symptoms and getting a professional evaluation will provide clarity and help you take the necessary steps for your health and well-being.

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