Background: To study pregnancy outcomes in patients presenting with spontaneous vaginal bleeding in first trimester.   Material and Methods:  This prospective cohort study was done in a tertiary care Centre over a period of 24 months and included a cohort of 116 patients with first trimester vaginal bleeding (Group A) whose pregnancy outcomes were compared with 106 patients with no such history. (Group B).   Results: Spontaneous abortions, Preterm deliveries and Small for gestational age babies were significantly more in women with history of first trimester vaginal bleeding (P≤0.05). However, there were no statistical significant differences in the other outcomes ( PROM , PPROM, NICU admissions and congenital anomalies)  studied.   Conclusion: First trimester vaginal bleeding may be responsible for the development of certain adverse pregnancy outcomes. Hence history of first trimester vaginal bleeding warrants close monitoring of the pregnancy for these adverse outcomes.