First Trimester – Answered by David Priver, MD, FACOG

Q. I am 11 weeks’ pregnant, and it’s my third pregnancy. Is it normal to start feeling your uterus above your pelvis at nine weeks? I can feel about two inches. Could it mean twins?

A. The height of the uterus within the pelvis is very variable, so I wouldn’t put much emphasis upon it. Twins are always a possibility, but that will very soon be determined via ultrasound.

Q. I’m in my first trimester and am eating less because I have no appetite. Will this affect my baby?

A. This is a very common first-trimester symptom. Unless it is quite severe, there is no danger to the baby as its nutritional needs are quite minimal at this point.

Q. I’m roughly six weeks’ pregnant and have been ok up until two days ago. After having gentle intercourse and now every other few times I go to the toilet, I’m wiping away thick mucus which looks to have faint bits of blood in it. I’m also having very gentle cramping. Is this normal?

A. Yes, it is. Blood vessels in the genital area tend to become a bit fragile during pregnancy, so very light flow is not considered abnormal, although levels approaching menses certainly would be. Also, the stretching of the uterus will cause mild cramping.

Q. Is it possible to have your period throughout your whole pregnancy?

A. It is possible to have intermittent bleeding episodes during pregnancy, usually for reasons that are not harmful. These episodes, however, are not “periods” in the traditional sense as menstrual activity ceases during pregnancy.

Q. I’m pregnant and wake up four or five times in the middle of the night because my left arm is numb and my fingers (mainly my middle finger) are as well. It is very painful. Is there anything I can do to relieve the pain? I have tried elevating my arm on a pillow, sleeping with a pillow between my legs, in front of my belly, etc.

A. This is called “carpal tunnel syndrome” and is very common during pregnancy due to water retention. There is a brace device that can be applied and that is usually quite helpful. Talk to your ob/gyn about this.

Q. I’m eight weeks pregnant. The doctor said the baby is hiding, and he couldn’t find the heartbeat. Should I be worried?

A. This depends upon what method the doctor used to try to detect the heartbeat. If it was a Doppler device in which only a sound is produced, then it would be quite a bit too early to hear the heartbeat. However, if this was a sonogram, in which a picture is produced, then the beating heart should definitely be detectable by eight weeks. Your doctor can follow this latter situation by repeating the sonogram in a week or two.

Q. I will be two months pregnant next week. I went for sonography two days ago, and my doctor said that no heartbeat can be detected. Is something wrong?

A. Not necessarily. You might not be as far along as you think; one third of menstrual pregnancy dates turn out to be incorrect. On the other hand, if you are essentially certain when you got pregnant, then by two months, or eight to nine weeks, a heartbeat should be easily seen on vaginal ultrasound. The matter can be settled by a combination of blood pregnancy hormone levels and repeat ultrasound tests.

Q. This is my third pregnancy. I miscarried the first two times. I had IUI for all. I got a call today from my nurse who said that my results for my pregnancy test was 1 week positive but it may be weak. The number I was told was 14 at the moment and that the right number should be 50. Can you tell me what the numbers mean? I have to go back in two days to have another blood test to see what the number is. I took a home pregnancy test the same day and it says positive. In my past pregnancies I was never told about numbers to have a positive result. I am seeing a new doctor for this IUI. In my last pregnancy I was pregnant with five, then reduced to three. I lost that pregnancy. I had a cerclage done but not at 12 weeks. It was at 17 weeks. I was already dilating when they did the stitch. For this pregnancy if it is in fact full positive I will need the stitch. Will I have to be on bed rest the whole time?

A. There are several questions here. As to the hormone numbers, there are no hard and fast rules, but 14 is considered extremely low and raises the possibility of early miscarriage. The next test will be important in answering that question. If you had a cerclage before, you’ll need it again. There’s no scientific evidence that bed rest adds anything to the success rate of pregnancy. You should discuss this with your doctor.

Q. This is my second pregnancy. I went to the ER at four weeks, three days due to brown spotting that turned red. Transvaginal US results show an elongated GS “moving slowly in utero” and comments in the report state “0 IUP seen.” I have been told that they suspect an ectopic pregnancy and I should expect the worse. Could they be a little ahead of themselves given that the pregnancy is so young? My cervix remains closed and is normal and I have a small amount of spotting with occasional mild cramps.

A. If they actually saw a “GS” (gestational sac) in the uterus, then ectopic pregnancy is most unlikely, almost a zero possibility. At four weeks, three days, no definitive signs of pregnancy are going to be seen on ultrasound. Serial quantitative HCG levels are helpful in a situation like this.

Q. I just found out I am pregnant with my first. I usually babysit two toddlers twice a week. My mother told me that being around them increases my risk of getting diseases that could affect my pregnancy. Is this true? I know many women have several toddlers when they get pregnant and it’s usually not a problem, but my mother insists it is an unnecessary risk. What is your opinion?

A. The risk would be extremely low, as the conditions which can adversely affect an early fetus are things that you almost certainly have had as a child yourself and, therefore, are immune from. That said, if you know for a fact that you’ve never had common childhood illnesses such as measles, mumps, chicken pox or German measles, then there is some risk involved and it would be best not to risk exposure until you’re past the first trimester.

Q. I purchased a fetal Doppler for home use and tried it at 10w3d and again at 10w6d. On the lower left side just above my pubic bone I pick up a fairly fast, faint swish-swish sound and also a much louder whistling-type sound, like wind down a tunnel. Problem is, I pick up the exact sounds in the same position on the right. A 6w3d the ultrasound showed only one sac and one h/b. Am I hearing my own femoral arteries? What is the wind sound?

A. At less than 12 weeks, a fetal Doppler is not going to be able to reliably detect fetal heart tones, so most likely you are hearing the pulsation of your own arteries. Blood circulating through an artery can cause a sound a bit like the rushing of wind.

Q. Does a weak positive mean that the baby was conceived within the last couple of weeks? If not, what does it mean?

A. All it means is that the HCG hormone level is low, which can mean a very early pregnancy or a later one that is in the process of being lost. If the pregnancy is healthy, the test should turn strongly positive in five to seven days.

Q. Two weeks ago I had a big cramp that lasted maybe two seconds, and in the morning I had a piece of what looked like pink tissue. However, there’s no blood and I’m almost three months pregnant. Should I be concerned?

A. Not if the event occurred two weeks ago and has not recurred. If anything important, such as a miscarriage were occurring, the bleeding would not be brief and limited, but would persist. Your doctor should be able to reassure you at your next visit.

Q. Using BBT I determined ovulation was on day 19 of my cycle. On day 29 I began spotting and had a what I thought was a light period for two days. Ten days later (39) I was having light spotting that was dark brown. I took a HPT and it was positive. A blood test the next day confirmed positive. A week (47) later my HPT is negative but I haven’t have any cramping or bleeding. Has the embryo stopped developing and am I going to miscarry? If yes how long until I actually miscarry?

A. It appears likely that you have already miscarried. Very early, there may not be more than a light bloody, brown discharge. An easy way to confirm this is to measure blood levels of the hormone HCG. If it is going down the pregnancy has been lost.

Q. I have decreasing HCG levels (153, then 109 a week later), but my cervix is closed and my uterus is enlarged. Could I be having a miscarriage?

A. A miscarriage is very likely under the conditions you describe. HCG levels should consistently rise throughout the first 10 to 12 weeks.

Q. I am 6 weeks pregnant. I had light spotting with small bits of tissue. I went to the ob/gyn and the ultrasound showed 1 sac with a strong heartbeat. I then had a gush of blood with a clot the day after. I had ivf and had 3 embryos transferred. My hcg level was also very high. Is it possible the blood is from miscarriage of one of the other embryos?

A. Yes, that is quite possible. This situation requires close follow-up with sonograms and possibly serial HCG levels. However, the visualization of a heart beat is a very favorable sign that at least one of the embryos will survive.

Q. What does an HCG of 600 mean?

A. It means nothing by itself other than that there is, or recently was, a pregnancy. What matters is how the number is changing. In a normal first trimester, the value should double every 72 hours from about 6 to 10 weeks. So, in order to take any valuable information from this test, it needs to be repeated in a few days in order to see if it’s increasing as it should.

Q. My daughter is six weeks pregnant. She was bleeding pretty badly, went to the hospital and was told the placenta was bleeding at the top. They said the baby was still fine but she had a 50-50 chance of losing it. She was put on bedrest (it has been a week) and the bleeding stopped for three days, but now she is bleeding a little again. What can she do to help stop the bleeding?

A. By “bleeding at the top” I suspect you mean that there was blood between the implanted egg and the wall of the uterus, what we call subchorionic hemorrhage. In most cases it subsides with no adverse potential for the fetus. It can be expected to stop on its own. However, if this does not occur by 7 to 10 days later, another sonogram is warranted to determine if the pregnancy is continuing.

Q. I am almost 11 weeks and having cramping. Is it normal? Also, should I not be lifting anything heavy or bending this early in the pregnancy? Will I miscarry if I do?

A. Cramping in the first trimester which is not accompanied by bleeding is a normal stretching phenomenon. It does not imply any higher than normal risk of miscarriage and does not require you to be at restricted activities.

Q. The last time I had a period was April 3. I took a pregnancy test in May, which was positive. I had a scan last week, which showed that the pregnancy was six weeks and five days, but from my calculation it ought to be ten to 11 weeks. What do you think?

A. This is a very common event in pregnancy. Fully one-third of the time, the correct gestational age as determined by ultrasound does not square with menstrual dates. From what you tell me, it is most likely that you got pregnant a few weeks later than you thought you did as a result of delayed ovulation. If, for example, your pregnancy test first showed positive in late May, you could have conceived around the middle of that month and still be only six to seven weeks by mid-June. This is why many of us are encouraging that ultrasound be done quite early in the pregnancy, so that a reliable due date can be established.

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