A patient in early pregnancy is reporting heavy bleeding. Based on this, what should a midwife suspect until proven otherwise?

In early pregnancy, heavy bleeding is a concerning symptom that can indicate a potential miscarriage, making threatened miscarriage a key suspicion. A threatened miscarriage is characterized by vaginal bleeding in the first trimester and may or may not be accompanied by cramping. When heavy bleeding occurs during this stage, it often points to complications related to the viability of the pregnancy.

While other options like implantation bleeding might explain light spotting, it would not account for the heavy bleeding described in the question. Ectopic pregnancy can also present with bleeding, but typically it includes other symptoms such as unilateral pain and is not the most common concern initially suspected with heavy bleeding. Normal menstruation is not applicable here, as the patient is in early pregnancy. Therefore, given the provided details, suspected heavy bleeding should primarily raise the concern of a threatened miscarriage until further evaluation can be conducted to confirm the situation.