Background: Per vaginal bleeding in the first trimester is a common obstetrical situation ranging from an insignificant episode to life-threatening emergency. The major causes are subchorionic hematoma, abortion, ectopic and molar pregnancies. Objectives of study: Ultrasonography is playing an increasing role in diagnosis of causes of Per vaginal bleeding in the first. This study was taken up to evaluate the value & utility of ultrasonography in correlation to the clinical findings of Per vaginal bleeding in the first trimester (sonographic evaluation). Materials & methods: In this prospective study all obstetric cases (with a history of per vaginal bleeding in the first trimester of pregnancy between April, 2023 to November, 2023 (of 8 months) were included. A complete general physical examination including pelvic examination was done to arrive at a clinical diagnosis. Patients were then subjected to ultrasound examination. Clinical and ultrasound findings were correlated. We attempted to identify the causes of vaginal bleeding occurring in the first trimester by clinical and trans-abdominal sonography & to evaluate the outcomes after instituting appropriate obstetric management. Results: 42 of all obstetric cases (200) had the First trimester bleeding (incidence being 21%). The common causes were subchorionic hemorrhage (28.57%), abortion (57.11%), molar (9.52%) & ectopic (4.80%) pregnancies. The bleeding cases were common in the younger age group 21 to 25 years, and more in the multigravida within 5 to 8(47%) weeks of gestational age. The commonest cause of bleeding was subchorionic hemorrhage (28.57%). Early institution of treatment after a proper diagnosis has decreased morbidity and, at times mortality of women. Ultrasound not only clinched the diagnosis but also helped in the timely management of first-trimester vaginal bleeding. Conclusion: Ultrasound is a simple, non-invasive diagnostic modality available in the current day practice to diagnose and to manage first trimester vaginal bleeding.