Early pregnancy bleeding (also called first trimester bleeding) refers to vaginal bleeding before 14 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.Common causes of early pregnancy bleeding include ectopic pregnancy, threatened miscarriage, and pregnancy loss. Most miscarriages occur before 12 weeks gestation age. Other causes include implantation bleeding, gestational trophoblastic disease, polyps, and cervical cancer. Tests to determine the underlying cause usually include a speculum examination, ultrasound, and hCG.Treatment depends on the underlying cause. If tissue is seen at the cervical opening it should be removed. For those in whom the pregnancy is intrauterine and who have fetal heart sounds, watchful waiting is generally appropriate. Anti-D immune globulin is usually recommended in those who are Rh-negative. Occasionally, surgery is required.About 30% of pregnant people have bleeding in the first trimester (0 to 14 weeks gestational age). Bleeding in the second trimester (12 to 24 weeks gestational age) is less common. About 15% of those who realize they are pregnant have a miscarriage. Ectopic pregnancy occurs in under 2% of pregnancies. Differential diagnosis
The differential diagnosis depends on whether the bleeding occurs in the first trimester or in the second or third trimesters. Obstetric causes of first trimester bleeding include the following:

Early pregnancy loss is a term often used interchangeably with spontaneous abortion and miscarriage and refers to pregnancy loss during the first trimester.
Pemphigus erythematosus  is simply a localized form of pemphigus foliaceus with features of  lupus erythematosus. See also
Pemphigus
List of cutaneous conditions
List of conditions caused by problems with junctional proteins

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