Fist trimester is very crucial period of pregnancy having high risks of pregnancy losses. The occurrence of first trimester bleeding is approximately 25% of all pregnancies. Vaginal bleeding in first trimester is a common complaint. Among these 200 patients, 19% patients aborted. Ectopic and molar pregnancy was seen in 5% and 1.5% patients respectively. Healthy fetus was present in 74.5% cases. Among abortion, missed abortion was seen in 9%, inevitable abortion in 2%, incomplete abortion in 7.5%, and complete abortion occurred in 0.5% cases. Fetal outcome included LBW (28.19%), preterm delivery (21.48%), IUGR (13.42%), fetal distress (11.41%), MSAF (7.38%), malpresentation (2.01%), congenital anomaly (1.34%), IUD and still birth (0.67% each).Neonatal outcome included NICU admission (12.08%), birth asphyxia (5.36%), RDS (4.03%), neonatal sepsis and neonatal jaundice (1.34% each). We concluded that patients with first trimester bleeding are at increased risk for spontaneous pregnancy loss and adverse fetal outcomes like preterm, intrauterine growth restriction, low birth weight, fetal distress, NICU admission and rarely congenital malformation where as there was no significant increase in perinatal mortality. So by knowing the etiology and fetal outcome of first trimester vaginal bleeding, we can predict the complications which will occur in later pregnancy and manage it properly.