Assessment of Prothrombin Time, International Normalized Ratio, and Platelet Count in Women with First-Trimester Vaginal Bleeding

Abstract

Background: Vaginal bleeding during the first trimester of pregnancy is a common clinical issue, affecting a significant proportion of women. Coagulation abnormalities such as prolonged prothrombin time (PT), elevated international normalized ratio (INR), and altered platelet count may play a role in the severity of bleeding and pregnancy outcomes. However, the relationship between coagulation parameters and early pregnancy complications remains inadequately explored.

Aim: The aim of this study was to evaluate PT, INR, and platelet count in women with first-trimester vaginal bleeding and examine their association with pregnancy outcomes.

Methods: This was a retrospective observational study conducted at Madhubani Medical College and Hospital, Madhubani, Bihar, over a period of two years. A total of 115 women presenting with vaginal bleeding during the first trimester of pregnancy were included. Coagulation parameters, including PT, INR, and platelet count, were assessed, and their relationship with pregnancy outcomes (viable pregnancy, threatened miscarriage, and complete miscarriage) was analyzed using SPSS version 23.0. Descriptive and inferential statistical methods were applied, with a significance level set at p < 0.05.

Results: The mean PT was 13.6 ± 1.4 sec, INR was 1.08 ± 0.12, and platelet count was 198.5 ± 48.3 × 10?/L. Women with a history of miscarriage had significantly higher PT and INR values compared to those without. Coagulation abnormalities (prolonged PT or INR >1.2) were observed in 16.5% of participants. A higher incidence of coagulation abnormalities was found in women presenting at later gestational weeks (10–12 weeks). Platelet count was inversely related to the severity of bleeding, with lower platelet counts observed in women with severe bleeding.

Conclusion: Coagulation abnormalities, particularly prolonged PT and elevated INR, were significantly associated with adverse pregnancy outcomes in women with first-trimester vaginal bleeding. Additionally, lower platelet counts were linked to increased bleeding severity. Early assessment of coagulation parameters can help predict pregnancy outcomes and guide clinical management.

Recommendations: Routine assessment of coagulation parameters should be considered in women presenting with first-trimester vaginal bleeding to identify those at higher risk for adverse outcomes. Further prospective studies with larger sample sizes are needed to explore the causal relationship between coagulation abnormalities and early pregnancy complications.

Keywords: First-trimester bleeding, prothrombin time, international normalized ratio, platelet count, pregnancy outcomes.