Bleeding in early pregnancy: when to worry
Every bleed deserves evaluation.

When to go straight to the ER

The book lists these situations as reasons to go directly to the emergency room, without waiting for a scheduled appointment:

• Heavy bleeding (more than one pad per hour)
• Severe abdominal pain, especially on one side
• Dizziness, pallor, fainting
• High fever with abdominal pain
• Uncontrollable vomiting, an inability to keep fluids down
• Shoulder pain with any bleeding
• Any concern outside business hours when you can't reach your doctor

Pain changes what bleeding means

Mild cramping early on is common: the uterus is growing and the ligaments are stretching. The book separates pain into levels:

• Normal: mild, occasional cramping, like light menstrual cramps, that passes with rest
• Pay attention: persistent pain that doesn't pass, or pain that gets progressively worse
• Urgent: severe one-sided pain, with or without bleeding (possible ectopic pregnancy)
• Urgent: severe generalized abdominal pain, with fever

Bleeding or pain after the positive is also one of the reasons the book gives for an earlier first OB appointment, by 6 weeks. And if you are exercising, stop immediately at any bleeding or severe pain.

This is one chapter. The map has 42.

Warning signs in the first trimester are Chapter 40 of Map to the Positive, in Station V (Positive). The book does not replace your doctor: it helps you tell what is common from what needs care, and tells you when to call and when to go. It is the whole map, from preparing to conceive through the first 30 days after a positive, so it is worth keeping for these weeks, or giving to someone who is still trying.