Clinical and Ultrasonographic Evaluation of Pregnant Women with First-trimester Bleeding

ORIGINAL ReseARchcause of vaginal bleeding, or on anticoagulants, and those who refused to give consent were excluded.The study commenced after institutional ethical approval, and consent from patients was obtained to enroll them in the study.This study was done for a period of 1.5 years, between July 2022 and December 2023.A total of 998 patients presenting with first-trimester bleeding were enrolled, of which 220 patients were either lost to follow-up or lost their sonographic images, 28 patients were on anticoagulants, and 22 patients refused to give consent.Therefore, a total of 728 patients were evaluated.Relevant clinical history, including demographic details and history of previous pregnancies, as well as physical examination, including pelvic examination if required, was done in all patients.Detailed history related to the present pregnancy, such as weeks of pregnancy at the time of the first episode of bleeding, duration and amount of bleeding, any associated abdominal pain, and history of IntroductIonVaginal spotting or bleeding in the first trimester of pregnancy is a common symptom, complicating 16-25% of all pregnancies. 1Metaanalyses indicate that vaginal bleeding during early pregnancy has a two-fold increase in complication risk, as described in various meta-analyses, and is a frequently encountered cause of anxiety to both parents and obstetricians. 2 Vaginal bleeding in the first trimester varies in amount and may range from insignificant spotting to a very significant amount, posing a life-threatening emergency. 3 According to the literature, the most common causes of bleeding in the first trimester of pregnancy are ectopic pregnancy, spontaneous or induced abortion, or gestational trophoblastic disease.However, the most frequently encountered reason is vaginal spotting caused by endometrial implantation of the growing conceptus.Clinical history and physical examination, along with laboratory testing and sonography, are used to diagnose the etiology of firsttrimester vaginal bleeding and to provide the most appropriate management.The objective of the present study is to evaluate clinically and ultrasonographically, identify the etiology of bleeding, assess the prognosis, and provide the most appropriate management. MaterIals a n d MethodsThis is a prospective observational hospital-based study that includes pregnant patients attending the OPD at the Department of Obstetrics and Gynecology, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur, with a complaint of vaginal bleeding in early pregnancy.All patients up to 12 weeks of pregnancy complaining of bleeding per vagina and who gave consent were included in the study.Patients presenting with vaginal bleeding after 12 completed weeks of pregnancy, having a nonobstetrical 1-