Prospective Evaluation of Pregnancy Outcomes in Women Presenting with First-Trimester Vaginal Bleeding

Background: First-trimester vaginal bleeding is a common obstetric complication, affecting approximately one-fifth of all clinically recognized pregnancies. While many such pregnancies continue normally, early bleeding has been associated with an increased risk of adverse maternal and fetal outcomes. However, the magnitude and pattern of these outcomes vary across populations, and prospective data from tertiary care settings remain limited.
Objectives: To prospectively evaluate maternal and fetal outcomes in pregnancies complicated by first-trimester vaginal bleeding and to assess the spectrum of adverse outcomes associated with this condition.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, Sylhet MAG Osmani Medical College Hospital and Mount Adora Hospital, Akhalia, Sylhet, Bangladesh from March 2021 to February 2022. Seventy (70) pregnant women presenting with vaginal bleeding during the first trimester (≤12 weeks of gestation) were enrolled. Women with ectopic pregnancy, molar pregnancy, known bleeding disorders, or pre-existing medical illnesses were excluded. Detailed clinical history, examination findings, and ultrasonographic parameters were recorded at presentation. Participants were followed throughout pregnancy to document maternal outcomes, including abortion, preterm labor, placenta previa, and placental abruption, as well as fetal outcomes such as birth weight, gestational age at delivery, intrauterine growth restriction, stillbirth, and neonatal intensive care unit admission.

Results: Of the 70 women studied, spontaneous abortion occurred in 30.0% of cases. Among pregnancies that progressed beyond the first trimester, 42.9% resulted in term delivery, while 17.1% ended in preterm birth. Maternal complications included preterm labor (24.5%), placenta previa (12.2%), and placental abruption (8.2%). Adverse fetal outcomes were common, with low birth weight observed in 30.6% of neonates, intrauterine growth restriction in 20.4%, and neonatal intensive care unit admission in 26.5% of cases.

Conclusion: First-trimester vaginal bleeding is associated with a significantly increased risk of pregnancy loss and adverse maternal and fetal outcomes. Pregnancies complicated by early bleeding should be considered high risk and require closer antenatal surveillance to improve perinatal outcomes.

Keywords: First-Trimester Vaginal Bleeding, Threatened Abortion, Pregnancy Outcome, Maternal Outcome, Fetal Outcome, Prospective Study.