Vaginal bleeding in first trimester is potentially alarming and approximately half of these women lose their pregnancies. This demands evaluation without deleterious effect on the embryo. A retrospective observational cohort study evaluating causes of first trimester vaginal bleeding in University of Uyo Teaching Hospital (UUTH), Uyo, Nigeria using ultrasonography. Criteria for admission into the study: (a) first-trimester vaginal bleeding; (b) an abdominal and/or transvaginal ultrasound scan performed in Department of Radiology, UUTH, Uyo on referral or repeated after 10days in cases of ambiguity. Outcome variables- viable pregnancy, incomplete miscarriage, complete miscarriage, ectopics, trophoblastic pregnancy, anembryonic pregnancy, embryonic demise, threatened miscarriage, subchoroinic haematoma and others. Results were statistically analyzed using SPSS Chicago 13. 645 women had first trimester obstetric ultrasonography during the period under review (8/1/2013-12/2/2016). 63.72% (n=411) of these women had first trimester vaginal bleeding. Peak frequency was seen in the 20-29 age range with 212 women (51.58%). The commonest ultrasonographic finding was incomplete miscarriage (n-221, 53.77%). This was followed by anembryonic pregnancy (n-42, 10.22%) and viable pregnancy (n-40, 9.73%). The least finding was trophoblastic pregnancy (n-2, 0-49%). The ratio of viable normal pregnancy to abnormal-complicated pregnancies was 1:9.27. 65.21% of all first trimester pregnancies with vaginal bleeding ended up in pregnancy loss. The most frequent ultrasonographic findings among women in Uyo, Nigeria with first trimester vaginal bleeding is incomplete miscarriage. The accompanying pregnancy loss far outweighed viability.
 

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