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15
O iginal Resea ch A icle
S udy o Foe o-Ma e nal Ou come in P egnancies wi h Fi s -T imes e
Bleeding Pe agina
Mampi Kha un1, Swa alipi Mis a2, Jayee a Mukhe jee3, Souga a Kuma Bu man4
1Senio Residen , Depa men o Obs e ics &Gynaecology, COM & JNM Hospi al, The Wes Bengal
Uni e si y o Heal h Sciences, Kalyani, Nadia- 741235, Wes Bengal, India
2RMO cum CT, Depa men o Obs e ics &Gynaecology, COM & JNM Hospi al, The Wes Bengal
Uni e si y o Heal h Sciences, Kalyani, Nadia- 741235, Wes Bengal, India
3Assis an P o esso , Depa men o Obs e ics &Gynaecology, COM & JNM Hospi al, The Wes Bengal
Uni e si y o Heal h Sciences, Kalyani , Nadia- 741235, Wes Bengal, India
4P o esso , Depa men o Obs e ics and Gynaecology, College o Medicine and JNM Hospi al, The Wes
Bengal Uni e si y o Heal h Sciences, Kalyani, Nadia- 741235, Wes Bengal
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 26-08-2025
Co esponding Au ho : D . Souga a Kuma Bu man
Con lic o in e es : Nil
Abs ac
In oduc ion: Fi s - imes e aginal bleeding is a common obs e ic complica ion occu ing in app oxima ely
20-25% o p egnancies and is a signi ican cause o conce n o pa ien s and clinicians alike. The e iology o
bleeding in ea ly p egnancy a ies widely, anging om benign causes such as implan a ion bleeding o mo e
se ious condi ions like h ea ened misca iage, ec opic p egnancy, and mola p egnancy.
Aims and Objec i es: To e alua e he oe o-ma e nal ou comes in p egnancies wi h i s - imes e aginal
bleeding and o assess i s associa ion wi h ad e se p egnancy, neona al, and ma e nal complica ions.
Ma e ials and Me hods: The p esen s udy was a P ospec i e s udy. This S udy was conduc ed om
Decembe 2020 o July2021 a Depa men o Obs e ics and Gynecology, Nil a anSi ca Medical College and
Hospi al, Kolka a. To al 60 pa ien s we e included in his s udy.
Resul : In ou s udy, 88.09% o cases wi h abno mal ul asound and 100% wi h an open ce ical os esul ed in
abo ion, while mode o deli e y showed no signi ican associa ion wi h ges a ional age (p=0.918). Among 21
li e-bo n neona es, 28.57% had IUGR and 23.81% had espi a o y dis ess, wi h 45% equi ing NICU
admission. Ma e nal complica ions included PIH in 30% and PPROM in 15% o cases.
Conclusion: In ou s udy, i s - imes e bleeding was associa ed wi h a wide spec um o ma e nal and neona al
ou comes. Vaginal deli e y was he p edominan mode o bi h, and women wi hou a p io his o y o abo ion
gene ally had mo e a o able p egnancy cou ses.
Keywo ds: Bleeding, P egnancy, Ou come, Abo ion.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access
Ini ia i e (h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium,
p o ided o iginal wo k is p ope ly c edi ed.
In oduc ion
Fi s - imes e aginal bleeding is a common
obs e ic complica ion occu ing in app oxima ely
20-25% o p egnancies and is a signi ican cause o
conce n o pa ien s and clinicians alike. The
e iology o bleeding in ea ly p egnancy a ies
widely, anging om benign causes such as
implan a ion bleeding o mo e se ious condi ions
like h ea ened misca iage, ec opic p egnancy, and
mola p egnancy [1,2].
This complica ion has been linked o inc eased
isks o ad e se p egnancy ou comes, including
misca iage, p e e m labo , low bi h weigh , and
pe ina al mo ali y [3]. Se e al s udies ha e
demons a ed ha i s - imes e bleeding may also
be associa ed wi h placen al abno mali ies such as
placen a p e ia and ab up ion, as well as e al
g ow h es ic ion [4, 5]. Ea ly iden i ica ion and
app op ia e moni o ing a e essen ial o imp o e
oe o-ma e nal ou comes in hese p egnancies.
Despi e ad ancemen s in diagnos ic and he apeu ic
s a egies, he e emains a lack o comp ehensi e
da a, especially om esou ce-limi ed se ings,
ega ding he ac o s in luencing p ognosis in
p egnancies complica ed by i s - imes e
bleeding. The e o e, his s udy aims o e alua e he
oe o-ma e nal ou comes associa ed wi h i s -
imes e bleeding pe agina, p o iding insigh o
be e clinical managemen and counseling.
Ma e ials and Me hods
S udy Type: P ospec i e s udy
S udy Design: Longi udinal S udy
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Kha un e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
16
Place o S udy: Depa men o Obs e ics and
Gynecology, Nil a an Si ca Medical College and
Hospi al, Kolka a.
Pe iod o S udy-Decembe 2020 o July2021
S udy Popula ion: Consen ing Pa ien s p esen ing
wi h i s imes e bleeding pe agina in OPD,
eme gency and indoo in he Depa men O
Obs e ics and Gynecology wi hin he s udy pe iod.
Inclusion C i e ia
1. Women wi h mon hs o ameno hea o <3
mon hs.
2. Women wi h posi i e p egnancy es .
3. Women wi h bleeding pe agina in i s
imes e o p egnancy.
Exclusion C i e ia
1.
Women wi h ch onic medical complica ions
including diabe es and hype ension.
2.
Women wi h a his o y o in e ili y.
3.
Women wi h bad obs e ic his o y (h/o >3 i s
imes e abo ion in p e ious p egnancy).
4.
Women wi h his o y o bleeding dia hesis.
5.
All pa ien wi h mo e han 12 comple ed weeks
o ges a ion.
6.
Mul iple ges a ions.
7.
Mola p egnancy.
Sample Size: So we ake 60 as minimal sample
size o he s udy.
S udy Va iables
• Age
• Pa i y
• Socioeconomic s a us
• Pe iod o ges a ion
• His o y o p e ious abo ion.
• P esen a ion
• Du a ion o bleeding
• Type o bleeding
• Ul asonog aphy examina ion
• Blood examina ion
• Gene al examina ion and Obs e ical
examina ion
S a is ical Analysis: Fo s a is ical analysis, da a
we e ini ially en e ed in o a Mic oso Excel
sp eadshee and hen analyzed using SPSS ( e sion
27.0; SPSS Inc., Chicago, IL, USA) and G aphPad
P ism ( e sion 5). Nume ical a iables we e
summa ized using means and s anda d de ia ions,
while Da a we e en e ed in o Excel and analyzed
using SPSS and G aphPad P ism. Nume ical
a iables we e summa ized using means and
s anda d de ia ions, while ca ego ical a iables
we e desc ibed wi h coun s and pe cen ages. Two-
sample - es s we e used o compa e independen
g oups, while pai ed - es s accoun ed o
co ela ions in pai ed da a. Chi-squa e es s
(including Fishe ’s exac es o small sample
sizes) we e used o ca ego ical da a compa isons.
P- alues ≤ 0.05 we e conside ed s a is ically
signi ican .
Resul
Table 1: Dis ibu ion o Pel ic Examina ion Findings, Mode o Deli e y, and P e ious Abo ion His o y
among S udy Pa icipan s
N
%
PV Examina ion
OS open
29
48.33
OS closed
30
50
No done
1
1.67
To al
60
100
Mode o Deli e y
Vaginal deli e y
15
71.43
LSCS
6
28.57
To al
21
100
P e ious abo ion
A0
41
68.33
A1
13
21.67
A2
6
10
To al
60
100
Table 2: Associa ion o Clinical and Ul asound Findings wi h P egnancy Ou comes in Women wi h
Fi s -T imes e Bleeding
Ou come
N
%
P- alue
Vaginal deli e y
Deli e y a e m
5
33.33
0.918
Deli e y a p e e m
10
66.67
To al
15
100
LSCS
Deli e y a e m
2
33.33
Deli e y a p e e m
4
66.67
To al
6
100
USG wi hin no mal limi
Abo ion
0
0
<0.001
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Lapa o omy
0
0
Deli e y a e m
7
38.89
Deli e y a p e e m
11
61.11
To al
18
100
USG abno mal
Abo ion
37
88.09
Lapa o omy
2
4.76
Deli e y a e m
0
0
Deli e y a p e e m
3
7.14
To al
42
100
OS open
Abo ion
29
100
<0.001
Lapa o omy
0
0
Deli e y a e m
0
0
Deli e y a p e e m
0
0
To al
29
100
OS closed
Abo ion
8
26.67
Lapa o omy
2
6.67
Deli e y a e m
7
23.33
Deli e y a p e e m
13
43.33
To al
30
100
No done
Abo ion
0
0
Lapa o omy
0
0
Deli e y a e m
0
0
Deli e y a p e e m
1
100
To al
1
100
Pas his o y o abo ion
(Spon aneous abo ion and MTP)
Abo ion
14
82.35
0.005
Lapa o omy
2
11.76
Deli e y a e m
0
0
Deli e y a p e e m
1
5.88
To al
17
100
Pas his o y o aginal deli e y
Abo ion
2
28.57
Lapa o omy
0
0
Deli e y a e m
2
28.57
Deli e y a p e e m
3
42.85
To al
7
100
Pas his o y o LSCS
Abo ion
2
33.3
Lapa o omy
0
0
Deli e y a e m
0
0
Deli e y a p e e m
4
66.7
To al
6
100
Table 3: Dis ibu ion o cases acco ding o neona al complica ions
Neona al complica ions
N
%
IUGR
6
28.57%
Jaundice
1
4.76
MAS
1
4.76
RDS
5
23.81
Nil
8
38.09
To al
21
100
Table 4: Dis ibu ion o cases acco ding o NICU admission o babies
NICU admission
N
%
Yes
10
45
No
11
55
To al
21
100
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Table 5: Showing ma e nal ou comes
Ma e nal ou comes
N
%
Se e e Anaemia
1
5
PIH
5
30
Placen a p e ia
2
10
Placen al ab up ion
1
5
PPH
1
5
PPROM
3
15
No complica ion
8
30
To al
21
100
Figu e 1: Dis ibu ion o cases acco ding o NICU admission o babies
Figu e 2: Showing ma e nal ou comes
In ou s udy, pe aginal examina ion e ealed ha
he majo i y o pa ien s had a closed ce ical os
(50%), ollowed closely by an open os in 48.33%
o cases, while in 1.67% he examina ion was no
pe o med. Among he 21 women who deli e ed,
aginal deli e y was he mos common mode
(71.43%), wi h lowe segmen caesa ean sec ion
(LSCS) accoun ing o 28.57% o deli e ies.
Rega ding p e ious obs e ic his o y, 68.33% o
women had no his o y o abo ion, whe eas 21.67%
had one abo ion and 10% had wo p e ious
abo ions.
In ou s udy, he mode o deli e y did no show a
s a is ically signi ican associa ion wi h ges a ional
age a deli e y (p=0.918), wi h bo h aginal
deli e y and LSCS g oups ha ing a highe
p opo ion o p e e m deli e ies (66.67% each)
compa ed o e m deli e ies (33.33%).
Ul asound indings we e s ongly associa ed wi h
p egnancy ou comes (p<0.001), as all cases wi h
no mal scans esul ed in li e bi hs (38.89% a e m
and 61.11% p e e m), whe eas abno mal scans
we e p edominan ly associa ed wi h abo ions
(88.09%) and a small p opo ion equi ed
lapa o omy (4.76%). Ce ical os s a us on pe
aginal examina ion also showed a signi ican
associa ion wi h ou come (p<0.001); all women
wi h an open os expe ienced abo ion, while hose
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Kha un e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
19
wi h a closed os had a ied ou comes, including
abo ion (26.67%), lapa o omy (6.67%), e m
deli e y (23.33%), and p e e m deli e y (43.33%).
Pas his o y o abo ion was signi ican ly ela ed o
ad e se ou comes (p=0.005), wi h he majo i y
(82.35%) esul ing in abo ion du ing he cu en
p egnancy. In con as , women wi h a his o y o
aginal deli e y o LSCS showed highe
p opo ions o p e e m deli e y (42.85% and
66.7%, espec i ely) compa ed o e m deli e ies.
In ou s udy, among he 21 li e-bo n neona es, he
mos common complica ion was in au e ine
g ow h es ic ion (IUGR) obse ed in 28.57% o
cases, ollowed by espi a o y dis ess synd ome
(RDS) in 23.81%. Jaundice and meconium
aspi a ion synd ome (MAS) we e no ed in 4.76%
each, while 38.09% o neona es had no
complica ions.
In ou s udy, ou o 21 li e-bo n neona es, 45%
equi ed NICU admission, while 55% did no
equi e any in ensi e ca e suppo .
In ou s udy, among he 21 women who deli e ed,
he mos common ma e nal complica ion was
p egnancy-induced hype ension (PIH) in 30% o
cases, ollowed by p e e m p ema u e up u e o
memb anes (PPROM) in 15% and placen a p e ia
in 10%. Se e e anaemia, placen al ab up ion, and
pos pa um haemo hage (PPH) we e each
obse ed in 5% o cases, while 30% o women had
no ma e nal complica ions.
Discussion
In ou s udy, ul asound indings and ce ical os
s a us we e he mos signi ican p edic o s o
p egnancy ou come, wi h abno mal scans and an
open os being s ongly associa ed wi h abo ion,
while no mal scans mo e equen ly esul ed in li e
bi hs. Simila esul s we e epo ed by De Vilbiss
e al. (2020) [6], who demons a ed ha
ans aginal ul asound indica o s such as e al
ca diac ac i i y and subcho ionic hema oma size
ha e high p ognos ic alue in i s - imes e
bleeding.
We ound ha all women wi h an open os abo ed,
consis en wi h Ami khani e al. (2013) [7], who
epo ed high a es o p egnancy loss in simila
cases. Pas his o y o abo ion in ou coho was
associa ed wi h a signi ican ly highe isk o
ad e se ou come, sugges ing ha ecu en ea ly
loss may e lec pe sis en isk ac o s such as
u e ine anomalies o placen al insu iciency. Ou
s udy also ound high a es o p e e m deli e y in
bo h aginal and LSCS g oups. Neona al
complica ions in ou se ies, no ably IUGR and
espi a o y dis ess synd ome. Collec i ely, ou
indings suppo he conclusion ha i s - imes e
bleeding, pa icula ly when accompanied by
abno mal ul asound o an open ce ical os,
wa an s igilan an ena al su eillance o op imize
bo h ma e nal and neona al ou comes.
Conclusion
In ou s udy, i s - imes e bleeding was associa ed
wi h a wide spec um o ma e nal and neona al
ou comes. Vaginal deli e y was he p edominan
mode o bi h, and women wi hou a p io his o y
o abo ion gene ally had mo e a o able
p egnancy cou ses. Ad e se ou comes we e
s ongly linked o abno mal ul asound indings and
an open ce ical os on pe aginal examina ion,
while a closed os was associa ed wi h mo e a ied
esul s. Neona al complica ions included g ow h
es ic ion and espi a o y dis ess, wi h some
equi ing in ensi e ca e admission. On he ma e nal
side, hype ensi e diso de s, p ema u e up u e o
memb anes, and placen al abno mali ies we e
no able complica ions, al hough a p opo ion o
women expe ienced no ad e se e en s. O e all, he
indings unde sco e he impo ance o ea ly
e alua ion and close an ena al moni o ing in
p egnancies complica ed by i s - imes e bleeding
o op imize ma e nal and neona al heal h.
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