THE RELATIONSHIP BETWEEN FIRST-TRIMESTER VAGINAL BLEEDING, FETAL GROWTH RESTRICTION, AND ADVERSE PERINATAL OUTCOMES

Abstract

Background: First-trimester vaginal bleeding is a common obstetric complication frequently associated with subchorionic hematoma (SCH). Although many affected pregnancies progress normally, early bleeding may reflect underlying placental dysfunction and has been linked to adverse pregnancy outcomes, including fetal growth restriction (FGR). Evidence regarding this association remains inconsistent across studies. Objective: To evaluate maternal characteristics and pregnancy outcomes in women with first-trimester vaginal bleeding, with particular emphasis on fetal growth restriction. Methods: We conducted this retrospective observational cohort study at the 6th Interdistrict Perinatal Centre, Tashkent, affiliated with Tashkent State Medical University, between March and December 2025. Medical records of 407 singleton pregnancies were reviewed, including 57 women with first-trimester vaginal bleeding and 350 controls without bleeding. We collected data on maternal characteristics, SCH localisation, medication use, and pregnancy outcomes. Outcomes assessed included early pregnancy loss, fetal growth restriction, preterm birth, preeclampsia, placental abruption, gestational diabetes mellitus, intrauterine fetal death, and mode of delivery. Results: Baseline maternal characteristics were comparable between groups. Early pregnancy loss and cesarean delivery were more frequent in women with first-trimester bleeding. However, the incidence of fetal growth restriction and other major adverse pregnancy outcomes was low and similar between groups. Conclusion: First-trimester vaginal bleeding was associated with an increased risk of early pregnancy loss but was not linked to a significant increase in fetal growth restriction in pregnancies progressing beyond the first trimester. These findings support a conservative, individualised clinical approach.