Abstract
Introduction First-trimester bleeding ranges from harmless spotting to signs of serious complications such as miscarriage, ectopic pregnancy, and molar pregnancy. It is associated with adverse maternal outcomes, including gestational hypertension and preeclampsia, as well as neonatal risks like preterm birth and low birth weight. Understanding the risk factors and outcomes can improve the monitoring and management of affected pregnancies. Methodology This prospective cohort study included 110 pregnant women presenting with first-trimester vaginal bleeding at a tertiary hospital. Participants were followed through pregnancy to record maternal and neonatal outcomes. Risk factors such as diabetes, hypertension, and thyroid disorders were analyzed. Bleeding severity was categorized, and its association with pregnancy outcomes was evaluated using statistical analysis to identify significant correlations. Results Among the 110 participants, 24 (21.8%) experienced spontaneous abortion, 26 (23.6%) had preterm births, and 60 (54.5%) delivered at term. Gestational hypertension was observed in 16 women (14.5%, p=0.038), and preeclampsia in 12 women (10.9%, p=0.047), both significantly associated with first-trimester bleeding. Among the 86 live births, neonatal complications included low birth weight in 25 neonates (29.1%), neonatal intensive care unit (NICU) admissions in 20 neonates (23.3%), and APGAR scores <7 at five minutes in 12 neonates (14.0%). The severity of bleeding was directly related to adverse outcomes: among 26 women with heavy bleeding, preterm birth occurred in nine (34.6%), gestational hypertension in five (19.2%), NICU admission in 10 (38.5%), and low birth weight in 11 (42.3%) (all p<0.05). Conversely, women with mild spotting (n=46) generally had more favorable outcomes, with 33 (70.7%) achieving term delivery. Conclusion First-trimester bleeding is a significant clinical concern linked to increased maternal and neonatal complications, especially when bleeding is moderate to severe. Identifying associated risk factors and closely monitoring affected pregnancies allows for timely interventions, improving maternal and fetal outcomes, and reducing adverse effects.