A study of maternal outcome in first trimester bleeding

Neerupham Bala, Navneet Kaur, Anand Shifali, Ajay Wakhloo, Nazia Tabassum


Background: The outcome of first trimester vaginal bleeding is a matter of debate. Vaginal bleeding is common and potentially alarming symptom in early pregnancy. First trimester bleeding is a common occurrence. It has been estimated to occur in 15-25% of all pregnant women. Objective of this study was to evaluate the various maternal outcomes in women with first trimester bleeding.

Methods: This prospective observational study was conducted in the postgraduate department of obstetrics and gynecology, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir, India. The study included 200 pregnant women presented with first trimester bleeding. All the women were followed prospectively till delivery and early postpartum period for various outcomes such as preterm delivery, PROM, PPROM, anemia, oligohydramnios, placental abruption, placenta previa and postpartum hemorrhage.

Results: Out of 200 patients studied, 19% patients aborted. Ectopic and molar pregnancy was seen in 5% and 1.5% patients respectively. Out of 74.5% patients who continued pregnancy, maternal complications included anemia (52%), PROM (14.09%), oligohydramnios (6.71%), placenta previa (5.37%), PPH (4.03%), PPROM (2.68%), preeclampsia (2.01%), gestational hypertension (1.34%), abruption and post-datism (0.67% each).

Conclusions: From the results of this study, it can be concluded that first trimester bleeding can be a predicting factor in terms of mother and infant consequences of pregnancy and it is necessary to increase the knowledge of pregnant women in this regard for closer care.


First trimester, Placenta previa, Preterm delivery, Pre-labor rupture of membrane, Vaginal bleeding

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Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Association between first trimester vaginal bleeding and miscarriage. Obstet Gynecol. 2009;114(4):860-67.

van Oppenraaij RH, Jauniaux E, Christiansen OB, Horcajadas JA, Farquharson RG, Exalto N, et al. Predicting adverse obstetric outcome after early pregnancy events and complications: A review. Hum Reprod Update. 2009;15:409-21.

Saraswat L, Bhattacharya S, Maheshwari A, Bhattacharya S. Maternal and perinatal outcome in women with threatened miscarriage in the first trimester: a systematic review. BJOG. 2010;117:245-57.

Fossum GT, Davajan V, Kletzky DA. Early detection of pregnancy with intravaginal ultrasound. Fertil Steril. 1988;49:788-91.

Choi H, Blaivas M, Lambert MJ. Gestational outcome in patients with first-trimester pregnancy complications and ultrasound-confirmed live intrauterine pregnancy. Acad Emerg Med. 2000;7(2):200-3.

Weiss JL, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Threatened abortion: A risk factor for poor pregnancy outcome, a population-based screening study. Am J Obstet Gynecol. 2004;190(3):745-50.

Wijesiriwardana A, Bhattacharya S, Shetty A, Smith N, Bhattacharya S. Obstetric outcome in women with threatened miscarriage in the first trimester. Obstet Gynecol. 2006;107:557-62.

Dadkhah F, Kashanian M, Eliasi G. A comparison between the pregnancy outcome in women both with or without threatened miscarriage. Early Hum Develop. 2010;86:193-6.

Lockwood CJ, Krikun G, Rahman M, Caze R, Buchwalder L, Schatz F. The role of decidualization in regulating endometrial hemostasis during the menstrual cycle, gestation and in pathological states. Semin Thromb Hemost. 2007;33:111-7.

Redman CW, Sargent IL. Preeclampsia, the placenta and the maternal systemic inflammatory response: A review. Placenta. 2003;24:S21-27.

Norwitz ER. Defective implantation and placentation: Laying the blueprint for pregnancy complications. Reprod Biomed Online. 2006;13:591-9.

Hustin J, Jauniaux E, Schaaps JP. Histological study of the materno-embryonic interface in spontaneous abortion. Placenta. 1990;11:477-86.

Kim YM, Chaiworapongsa T, Gomez R, Bujold E, Yoon BH, Rotmensch S, et al. Failure of physiological transformation of the spiral arteries in the placental bed in preterm premature rupture of membranes. Am J Obstet Gynecol. 2002;187:1137-42.

John J, Jauniaux E. Threatened miscarriage as a predictor of obstetric outcome. Obstet Gynecol. 2006;107:845-50.

Yang J, Hartmann KE, Savitz DA, Herring AH, Dole N, Olshan AF, et al. Vaginal bleeding during pregnancy and preterm birth. Am J Epidemiol. 2004;160:118-25.

Dwivedi S, Verma K, Malhotra V, Jahan U, Gupta N, Verma S, et al. Pregnancy outcome in threatened miscarriage and correlation with USG parameters. Inter J Recent Sci Res. 2017;8(2):15539-43.

Perera BH, De Silva AP, Perera H. A case-control study on the effect of threatened miscarriage on selected pregnancy outcomes. Sri Lanka J Obstet Gynaecol. 2009;31:34-8.

Patel NG, Patel MS, Shah SR, Jani SK, Patel JA, Shah JU. Study of outcome of pregnancy in patients with first-trimester bleeding per vaginum. Int J Adv Med. 2014;1(3):230-3.

Patel S. Pregnancy outcome of patients complicated by threatened abortion. IOSR-JDMS. 2016;15(12):18-22.

Williams M, Goldman M, Mittendorf R, Lieberman E, Monson R. Adverse infant outcomes associated with first-trimester bleeding. Obstet Gynecol. 1991;78(1):141-8.

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):57-61.

Kouk LJ, Neo GH, Malhotra R, Allen JC, Beh ST, Tan TC, et al. A prospective study of risk factors for first trimester miscarriage in Asian women with threatened miscarriage. Singapore Med J. 2013;54(8):425-31.

Jasoliya J, Bhatia S. Study of fetal outcome in cases of bleeding per vaginum in first trimester of pregnancy. IJSR. 2017;6(2):1543-5.

Rai P, Kumari G, Kumari K, Jaiswal D. Evaluation of perinatal outcome in women presented with first trimester vaginal bleeding: our experience. Inter J Reprod Contracept Obstet Gynecol. 2017;6(3):829-32.

Sarmalkar MS, Singh S, Nayak AH. Maternal and perinatal outcome in women with threatened abortion in first trimester. Int J Reprod Contracept Obstet Gynecol. 2016;5(5):1438-45.

Yakistiran B, Yuce T, Soylemez F. First trimester bleeding and pregnancy outcomes: Case-control study. Inter J Women’s Health Reprod Sci. 2016;4(1):4-7.

Mulik V, Bethel J, Bhai K. A retrospective population-based study of primigravida women on the potential effect of threatened miscarriage on obstetric outcome. J Obstet Gynecol. 2004;24(3):249-53.

Davari-Tanha F, 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 O, Langhoff-Roos J. First trimester vaginal bleeding and complications later in pregnancy. Obstet Gynecol. 2010;115:935-44.

Bahad M, Singh MB, Chikitsalaya M. A prospective study of outcome of pregnancy complicated by threatened abortion. IOSR-JDMS. 2016;15(6):20-3.

Guruvare S, Medipalli P, Urala SM, Rai L, Hebbar S, Adiga P. Factors influencing pregnancy outcome in women with vaginal bleeding before midpregnancy: a prospective case control study. Int J Reprod Contracept Obstet Gynecol. 2015;4(3):601-5.

Barik S, Javed S, Datta S, Chowdhury B, Datta P. Outcome of pregnancies having bleeding per vagina in the first trimester. J Evol Med Dent Sci. 2016;5(55):3750-5.

Kamble PD, Bava A, Shukla M, Nandanvar YS. First trimester bleeding and pregnancy outcome. Inter J Reprod Contracept Obstet Gynecol. 2017;6(4):1484-7.

Khanam M, Yusuf N, Ashraf F. Outcome of threatened abortion in a series of 100 cases in RMCH. J Teacher Association. 2005;18(2):76-9.