Introduction: Vaginal bleeding in the first trimester is a common obstetric situation ranging from an insignificant episode to life threatening emergency. The major causes include abortion, ectopic pregnancy and molar pregnancy. In determining the causes of first trimester bleeding, ultrasound (both abdominal and TVS) plays an important role in prognosticating and predicting the status of abnormal pregnancies This study was taken up to evaluate its utility vis-à-vis clinical examination findings. Aims and objectives: a) Sonological evaluation of clinically first trimester bleeding. b) To prognosticate and predict the status of abnormal pregnancies. c) To evaluate the uterine structural defects which leads to repeated abortions. Materials and methods: After obtaining written informed consent, 100 patients referred to the Department of Radiodiagnosis and Imaging, Government Medical College and Guru Nanak Dev Hospital, Amritsar with history of the first trimester bleeding for the sonographic evaluation were examined by ultrasound (TAS/TVS). Results: Among these 100 cases, incomplete abortion (IA) was the most common cause of bleeding. This was observed in 73 cases (73%). There were 11 (11%) cases of ectopic gestation in the present study. Missed abortion in 4 (4%) and threatened abortion in 2 (2%) cases respectively. There were 5 (5%) cases of early pregnancy failure, 3 (3%) cases of hydatidiform mole and 2 (2%) case of AVM. There was significant correlation between duration of amenorrhea, pain abdomen and duration of bleeding with sonographic and final clinical diagnosis. Conclusion: Ultrasound is a valuable tool in the differentiation of causes of first trimester vaginal bleeding. Ultrasound is helpful in the decision-making algorithm about the safe continuation of the pregnancy and timely intervention for abnormal pregnancy.