Study of Foeto-Maternal Outcome in Pregnancies with First-Trimester Bleeding Pervagina

e-ISSN: 0976-822X, p-ISSN:2961-6042 Available online on http://www.ijcpr.com/ International Journal of Current Pharmaceutical Review and Research 2025; 17(9); 15-20 Khatun et al. International Journal of Current Pharmaceutical Review and Research 15 Original Research Article Study of Foeto-Maternal Outcome in Pregnancies with First-Trimester Bleeding Pervagina Mampi Khatun1, Swaralipi Misra2, Jayeeta Mukherjee3, Sougata Kumar Burman4 1Senior Resident, Department of Obstetrics &Gynaecology, COM & JNM Hospital, The West Bengal University of Health Sciences, Kalyani, Nadia741235, West Bengal, India 2RMO cum CT, Department of Obstetrics &Gynaecology, COM & JNM Hospital, The West Bengal University of Health Sciences, Kalyani, Nadia741235, West Bengal, India 3Assistant Professor, Department of Obstetrics &Gynaecology, COM & JNM Hospital, The West Bengal University of Health Sciences, Kalyani , Nadia741235, West Bengal, India 4Professor, Department of Obstetrics and Gynaecology, College of Medicine and JNM Hospital, The West Bengal University of Health Sciences, Kalyani, Nadia741235, West Bengal Received: 01-06-2025 / Revised: 16-07-2025 / Accepted: 26-08-2025 Corresponding Author: Dr. Sougata Kumar Burman Conflict of interest: Nil Abstract Introduction: First-trimester vaginal bleeding is a common obstetric complication occurring in approximately 20-25% of pregnancies and is a significant cause of concern for patients and clinicians alike. The etiology of bleeding in early pregnancy varies widely, ranging from benign causes such as implantation bleeding to more serious conditions like threatened miscarriage, ectopic pregnancy, and molar pregnancy. Aims and Objectives: To evaluate the foeto-maternal outcomes in pregnancies with first-trimester vaginal bleeding and to assess its association with adverse pregnancy, neonatal, and maternal complications. Materials and Methods: The present study was a Prospective study. This Study was conducted from December2020 to July2021 at Department of Obstetrics and Gynecology, NilratanSircar Medical College and Hospital, Kolkata. Total 60 patients were included in this study. Result: In our study, 88.09% of cases with abnormal ultrasound and 100% with an open cervical os resulted in abortion, while mode of delivery showed no significant association with gestational age (p=0.918). Among 21 live-born neonates, 28.57% had IUGR and 23.81% had respiratory distress, with 45% requiring NICU admission. Maternal complications included PIH in 30% and PPROM in 15% of cases. Conclusion: In our study, first-trimester bleeding was associated with a wide spectrum of maternal and neonatal outcomes. Vaginal delivery was the predominant mode of birth, and women without a prior history of abortion generally had more favorable pregnancy courses. Keywords: Bleeding, Pregnancy, Outcome, Abortion. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. Introduction First-trimester vaginal bleeding is a common obstetric complication occurring in approximately 20-25% of pregnancies and is a significant cause of concern for patients and clinicians alike. The etiology of bleeding in early pregnancy varies widely, ranging from benign causes such as implantation bleeding to more serious conditions like threatened miscarriage, ectopic pregnancy, and molar pregnancy [1,2]. This complication has been linked to increased risks of adverse pregnancy outcomes, including miscarriage, preterm labor, low birth weight, and perinatal mortality [3]. Several studies have demonstrated that first-trimester bleeding may also be associated with placental abnormalities such as placenta previa and abruption, as well as fetal growth restriction [4, 5]. Early identification and appropriate monitoring are essential to improve foeto-maternal outcomes in these pregnancies. Despite advancements in diagnostic and therapeutic strategies, there remains a lack of comprehensive data, especially from resource-limited settings, regarding the factors influencing prognosis in pregnancies complicated by first-trimester bleeding. Therefore, this study aims to evaluate the foeto-maternal outcomes associated with firsttrimester bleeding per vagina, providing insight for better clinical management and counseling. Materials and Methods Study Type: Prospective study Study Design: Longitudinal Study International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Khatun et al. International Journal of Current Pharmaceutical Review and Research 16 Place of Study: Department of Obstetrics and Gynecology, Nilratan Sircar Medical College and Hospital, Kolkata. Period of Study-December2020 to July2021 Study Population: Consenting Patients presenting with first trimester bleeding per vagina in OPD, emergency and indoor in the Department Of Obstetrics and Gynecology within the study period. Inclusion Criteria 1. Women with months of amenorrhea of <3 months. 2. Women with positive pregnancy test. 3. Women with bleeding pervagina in first trimester of pregnancy. Exclusion Criteria 1. Women with chronic medical complications including diabetes and hypertension. 2. Women with a history of infertility. 3. Women with bad obstetric history (h/o >3 first trimester abortion in previous pregnancy). 4. Women with history of bleeding diathesis. 5. All patient with more than 12 completed weeks of gestation. 6. Multiple gestations. 7. Molar pregnancy. Sample Size: So we take 60 as minimal sample size for the study. Study Variables • Age • Parity • Socioeconomic status • Period of gestation • History of previous abortion. • Presentation • Duration of bleeding • Type of bleeding • Ultrasonography examination • Blood examination • General examination and Obstetrical examination Statistical Analysis: For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analyzed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Twosample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant. Result Table 1: Distribution of Pelvic Examination Findings, Mode of Delivery, and Previous Abortion History among Study Participants N % PV Examination OS open 29 48.33 OS closed 30 50 Not done 1 1.67 Total 60 100 Mode of Delivery Vaginal delivery 15 71.43 LSCS 6 28.57 Total 21 100 Previous abortion A0 41 68.33 A1 13 21.67 A2 6 10 Total 60 100 Table 2: Association of Clinical and Ultrasound Findings with Pregnancy Outcomes in Women with First-Trimester Bleeding Outcome N % P-value Vaginal delivery Delivery at term 5 33.33 0.918 Delivery at preterm 10 66.67 Total 15 100 LSCS Delivery at term 2 33.33 Delivery at preterm 4 66.67 Total 6 100 USG within normal limit Abortion 0 0 <0.001 International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Khatun et al. International Journal of Current Pharmaceutical Review and Research 17 Laparotomy 0 0 Delivery at term 7 38.89 Delivery at preterm 11 61.11 Total 18 100 USG abnormal Abortion 37 88.09 Laparotomy 2 4.76 Delivery at term 0 0 Delivery at preterm 3 7.14 Total 42 100 OS open Abortion 29 100 <0.001 Laparotomy 0 0 Delivery at term 0 0 Delivery at preterm 0 0 Total 29 100 OS closed Abortion 8 26.67 Laparotomy 2 6.67 Delivery at term 7 23.33 Delivery at preterm 13 43.33 Total 30 100 Not done Abortion 0 0 Laparotomy 0 0 Delivery at term 0 0 Delivery at preterm 1 100 Total 1 100 Past history of abortion (Spontaneous abortion and MTP) Abortion 14 82.35 0.005 Laparotomy 2 11.76 Delivery at term 0 0 Delivery at preterm 1 5.88 Total 17 100 Past history of vaginal delivery Abortion 2 28.57 Laparotomy 0 0 Delivery at term 2 28.57 Delivery at preterm 3 42.85 Total 7 100 Past history of LSCS Abortion 2 33.3 Laparotomy 0 0 Delivery at term 0 0 Delivery at preterm 4 66.7 Total 6 100 Table 3: Distribution of cases according to neonatal complications Neonatal complications N % IUGR 6 28.57% Jaundice 1 4.76 MAS 1 4.76 RDS 5 23.81 Nil 8 38.09 Total 21 100 Table 4: Distribution of cases according to NICU admission of babies NICU admission N % Yes 10 45 No 11 55 Total 21 100 International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Khatun et al. International Journal of Current Pharmaceutical Review and Research 18 Table 5: Showing maternal outcomes Maternal outcomes N % Severe Anaemia 1 5 PIH 5 30 Placenta previa 2 10 Placental abruption 1 5 PPH 1 5 PPROM 3 15 No complication 8 30 Total 21 100 Figure 1: Distribution of cases according to NICU admission of babies Figure 2: Showing maternal outcomes In our study, per vaginal examination revealed that the majority of patients had a closed cervical os (50%), followed closely by an open os in 48.33% of cases, while in 1.67% the examination was not performed. Among the 21 women who delivered, vaginal delivery was the most common mode (71.43%), with lower segment caesarean section (LSCS) accounting for 28.57% of deliveries. Regarding previous obstetric history, 68.33% of women had no history of abortion, whereas 21.67% had one abortion and 10% had two previous abortions. In our study, the mode of delivery did not show a statistically significant association with gestational age at delivery (p=0.918), with both vaginal delivery and LSCS groups having a higher proportion of preterm deliveries (66.67% each) compared to term deliveries (33.33%). Ultrasound findings were strongly associated with pregnancy outcomes (p<0.001), as all cases with normal scans resulted in live births (38.89% at term and 61.11% preterm), whereas abnormal scans were predominantly associated with abortions (88.09%) and a small proportion required laparotomy (4.76%). Cervical os status on per vaginal examination also showed a significant association with outcome (p<0.001); all women with an open os experienced abortion, while those International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Khatun et al. International Journal of Current Pharmaceutical Review and Research 19 with a closed os had varied outcomes, including abortion (26.67%), laparotomy (6.67%), term delivery (23.33%), and preterm delivery (43.33%). Past history of abortion was significantly related to adverse outcomes (p=0.005), with the majority (82.35%) resulting in abortion during the current pregnancy. In contrast, women with a history of vaginal delivery or LSCS showed higher proportions of preterm delivery (42.85% and 66.7%, respectively) compared to term deliveries. In our study, among the 21 live-born neonates, the most common complication was intrauterine growth restriction (IUGR) observed in 28.57% of cases, followed by respiratory distress syndrome (RDS) in 23.81%. Jaundice and meconium aspiration syndrome (MAS) were noted in 4.76% each, while 38.09% of neonates had no complications. In our study, out of 21 live-born neonates, 45% required NICU admission, while 55% did not require any intensive care support. In our study, among the 21 women who delivered, the most common maternal complication was pregnancy-induced hypertension (PIH) in 30% of cases, followed by preterm premature rupture of membranes (PPROM) in 15% and placenta previa in 10%. Severe anaemia, placental abruption, and postpartum haemorrhage (PPH) were each observed in 5% of cases, while 30% of women had no maternal complications. Discussion In our study, ultrasound findings and cervical os status were the most significant predictors of pregnancy outcome, with abnormal scans and an open os being strongly associated with abortion, while normal scans more frequently resulted in live births. Similar results were reported by De Vilbiss et al. (2020) [6], who demonstrated that transvaginal ultrasound indicators such as fetal cardiac activity and subchorionic hematoma size have high prognostic value in first-trimester bleeding. We found that all women with an open os aborted, consistent with Amirkhani et al. (2013) [7], who reported high rates of pregnancy loss in similar cases. Past history of abortion in our cohort was associated with a significantly higher risk of adverse outcome, suggesting that recurrent early loss may reflect persistent risk factors such as uterine anomalies or placental insufficiency. Our study also found high rates of preterm delivery in both vaginal and LSCS groups. Neonatal complications in our series, notably IUGR and respiratory distress syndrome. Collectively, our findings support the conclusion that first-trimester bleeding, particularly when accompanied by abnormal ultrasound or an open cervical os, warrants vigilant antenatal surveillance to optimize both maternal and neonatal outcomes. Conclusion In our study, first-trimester bleeding was associated with a wide spectrum of maternal and neonatal outcomes. Vaginal delivery was the predominant mode of birth, and women without a prior history of abortion generally had more favorable pregnancy courses. Adverse outcomes were strongly linked to abnormal ultrasound findings and an open cervical os on per vaginal examination, while a closed os was associated with more varied results. Neonatal complications included growth restriction and respiratory distress, with some requiring intensive care admission. On the maternal side, hypertensive disorders, premature rupture of membranes, and placental abnormalities were notable complications, although a proportion of women experienced no adverse events. Overall, the findings underscore the importance of early evaluation and close antenatal monitoring in pregnancies complicated by first-trimester bleeding to optimize maternal and neonatal health. Reference 1. Amirkhani Z, Akhlaghdoust M, Abedian M, Salehi GR, Zarbati N, Mogharehabed M, Arefian S, Jafarabadi M. Maternal and perinatal outcomes in pregnant women with first trimester vaginal bleeding. Journal of family & reproductive health. 2013 Jun;7(2):57. 2. Yakistiran B, Yuce T, Soylemez F. 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