A study of feto-maternal outcome in bleeding per vaginum in first trimester of pregnancy

Jaydeep J. Bhatu, Darshil S. Prajapati


Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.

Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.

Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.

Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.


Abortion, Bleeding per vaginum, H. Mole, Medical termination of pregnancy, Placenta previa, Subchorionic hematoma

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eutchman M, Tubay AT, Turok DK. First trimester bleeding. Am Fam Phys. 2009;79(11):985-92.

Evrenos AN, Gungor AN, Gulerman C, Cosar E. Obstetric outcomes of patients with abortus imminens in the first trimester. Arch Gynecol Obstet. 2014;289(3):499-504.

Williams MA, Mittendorf RO, Lieberman EL, Monson RR. Adverse infant outcomes associated with first-trimester vaginal bleeding. Obstet Gynecol. 1991;78(1):14-8.

Amirkhani Z, Akhlaghdoust M, Abedian M, Salehi GR, Zarbati N, Mogharehabed M, et al. Maternal and perinatal outcomes in pregnant women with first trimester vaginal bleeding. J Fam Reprod Health. 2013;7(2):57.

Reddirani P, Sunita V. Ultrasound evaluation of cause of vaginal bleeding in first trimester of pregnancy. J Obstet Gynecol Ind. 2000;50(l):54-8.

Sofat R. Ultrasound evaluation of bleeding in early pregnancy. J Obstet Gynecol Ind. 1987;31:344-7.

Sipila P, Haritikainen-Sorri AL, Oja H, Von Wendt L. Perinatal outcome of pregnancies complicated by vaginal bleeding. Br J Obstet Gynecol. 1992;99(12):959-63.

Bharadwaj N. Sonography evaluation as an aid in the management of bleeding in early pregnancy. J Obstet Gynaecol India. 1998;38:640-2.

Maso G, D'Ottavio G, De Seta F, Sartore A, Piccoli M, Mandruzzato G. First-trimester intrauterine hematoma and outcome of pregnancy. Obstet Gynecol. 2005;105(2):339-44.

Davari TF, Shariat M, Kaveh M, Ebrahimi M, Jalalvand S. Threatened abortion: a risk factor for poor pregnancy outcome. Acta Medica Iranica. 2008;46(4):314-20.

Lykke JA, Dideriksen KL, Lidegaard Ø, Langhoff-Roos J. First-trimester vaginal bleeding and complications later in pregnancy. Obstet Gynecol. 2010;115(5):935-44.

Kamble PD, Bava A, Shukla M, Nandanvar YS. First trimester bleeding and pregnancy outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6:1484-7.

Sarmalkar MS, Singh S, Nayak AH, Das TK. Maternal and perinatal outcome in women with threatened abortion in first trimester. Int J Reprod Contracept Obstet Gynecol. 2016;5(5):1439.