Clinical and Ultrasonographical Evaluation of First Trimester Vaginal Bleeding

Abstract

Introduction: First-trimester vaginal bleeding is among the most frequent complications in early pregnancy, with variable etiologies ranging from benign to life-threatening conditions. Accurate diagnosis through clinical assessment and ultrasonography is critical for optimizing maternal and fetal outcomes. The objective of the study is to determine the incidence, causes, and outcomes of first-trimester vaginal bleeding through clinical and ultrasonographic evaluation.

Material and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, B.G. Nagara, from June 2023 to December 2024. A total of 100 pregnant women with bleeding per vagina up to 12 weeks of gestation were included. Clinical history, physical examination, and ultrasonography were performed. Data were analyzed using SPSS, with Chi-square tests applied to assess correlations.

Results: Most participants were aged 21–30 years, with 56% being multigravida. Abdominal pain was reported by 65%, and 90% had a closed cervical os. Vaginal bleeding was moderate in 45% and severe in 20%, the latter associated with lower hemoglobin levels (mean 7.38 g/dL). Clinically, threatened abortion was suspected in 78% of cases, but ultrasound confirmed only 54%, while additionally diagnosing missed abortion (13%), ectopic pregnancy (9%), blighted ovum (5%), and molar pregnancy (3%). The difference between clinical and ultrasonographic diagnosis was statistically significant (p=0.0089). Among threatened abortion cases, 39% resulted in full-term vaginal delivery, 33% in preterm birth, 20% in caesarean section, and 7% ended in abortion.

Conclusion: First-trimester vaginal bleeding poses significant maternal and fetal risks. Ultrasonography is indispensable for accurate diagnosis, early intervention, and improving pregnancy outcomes.