PREVALENCE, CAUSES AND OUTCOMES OF BLEEDING IN FIRST TRIMESTER OF PREGNANCY

Abstract

Bleeding during the first trimester of pregnancy is one of the most frequent obstetric complications, affecting nearly 20–25% of all clinically recognized pregnancies. It is a major source of anxiety for the patient and a challenge for the clinician, as the underlying causes range from benign conditions such as implantation bleeding to more serious outcomes like miscarriage and ectopic pregnancy. The etiology, prevalence, and clinical outcomes of first-trimester bleeding vary depending on regional, demographic, and clinical factors, making it important to study in institutional settings. Aim: The aim of this study was to determine the prevalence, causes, and outcomes of bleeding in the first trimester of pregnancy among women presenting to the Department of Obstetrics and Gynaecology at Government Medical College (GMC) Kathua. Methods: This was a hospital-based observational study conducted at GMC Kathua from October  2023 to September  2024. A total of 100 pregnant women presenting with first-trimester bleeding were included. Data were collected regarding demographic profile, gestational age, clinical presentation, causes of bleeding, laboratory investigations, ultrasonographic findings, and maternal-fetal outcomes. The prevalence of first-trimester bleeding among all antenatal cases was calculated, and statistical analysis was applied to assess associations between different causes and outcomes. Results: Among the study population of 100 patients, the prevalence of first-trimester bleeding was estimated at 12% of total antenatal visits during the study period. The most common cause identified was threatened abortion (42%), followed by incomplete abortion (18%), inevitable abortion (12%), missed abortion (10%), and ectopic pregnancy (8%). Other causes included molar pregnancy (5%) and unexplained bleeding (5%). Maternal age between 21 and 30 years constituted the majority of cases (65%). Favorable pregnancy continuation was observed in 48% of women, while 52% had adverse outcomes including miscarriage, surgical intervention for ectopic pregnancy, or progression to molar gestation requiring evacuation. Conclusion: First-trimester bleeding is a common clinical problem with multifactorial etiology and significant implications for maternal and fetal outcomes. Early evaluation with clinical examination and ultrasound helps in accurate diagnosis and timely management. Strengthening awareness among women and ensuring early referral are crucial in reducing complications. The findings of this study contribute to regional data from North India and highlight the importance of vigilant antenatal care in the first trimester.