Observational Study of Patients Presenting with Bleeding in First Trimester

Abstract

Objective: First trimester is an important period during which there is risk of bleeding and may lead to
spontaneous abortion. More than 80% spontaneous abortions occur in first trimester. The aim of this study
was to determine the causes of first trimester bleeding.
Method: This was a cross sectional descriptive study conducted at Shalinitai Meghe hospital and Research
centre Hingana, Nagpur during January 2020 to June 2020. The patients presenting to OPD with history of
bleeding or spotting per vaginum, positive urine pregnancy test and less than 12 weeks of gestation were
included in this study. Clinical examination and ultrasonography was done.
Result: Most of the patients presented with moderate bleeding and associated pain. The duration of bleeding
was 2 to 5 days. Majority of cases were between 4-8 weeks (69.5%). History of prior miscarriage was present
in 23.7%. 61% of cases were anemic. Threatened abortion was most common in patients presenting with
bleeding per vaginum (in 47.5%). 18.6% patients were with incomplete abortion and 11.8% had complete
abortion. There were 2 cases of unruptured ectopic pregnancy and 1 case of ruptured ectopic pregnancy.
Salpingectomy was done in all the 3. Dilatation and evacuation was done in 12 cases. Gestational sac was
present in 52 cases and the appearance was normal in 53.8% cases. Yolk sac was present in 65.4% cases.
Fetal pole and cardiac activity was seen in 57.7%cases.
Conclusion: Bleeding in first trimester of pregnancy is the common complaint with which the pregnant
women presents to the health care worker. The commonest cause is the threatened abortion. Other causes
are incomplete, complete and missed abortions. Bleeding in early pregnancy may be early presentation of a
serious situation like ectopic pregnancy. Ultrasonography, especially the Trans Vaginal is very important in
concluding the causes of bleeding. Pregnant women should be educated in the first visit to antenatal OPD
itself for the symptoms like bleeding per vaginum and to seek help from health care worker as soon as
possible.