Background: Recurrent miscarriage (RM) is a distressing condition affecting 1-5% of couples experiencing infertility and 12-15% of pregnancies. Many cases go unrecognized due to losses occurring before clinical recognition, and the etiology of recurrent first-trimester miscarriage (RFM) remains unclear. Abnormal coagulation has been implicated in RFM, leading to the investigation of low molecular weight heparin (LMWH) as a potential intervention. However, research on LMWH's role in the Indian population, with its unique genetic and cultural factors, is limited. This study aims to evaluate the effectiveness and safety of LMWH in Indian women with unexplained RFM, providing insights into pregnancy outcomes and complications. Methods: This prospective hospital-based study was conducted over a period of two years. The participants consisted of pregnant women in their first trimester, with unexplained recurrent first trimester miscarriage. A total of 154 participants were monitored throughout their entire pregnancy period. The intervention involved the administration of low molecular weight heparin (LMWH) to the study participants at a prescribed standardized dosage. The primary outcome measures were the incidence of successful ongoing pregnancies beyond 20 weeks of gestation and the live birth rate. Results: The study included 154 pregnant women with unexplained recurrent first-trimester miscarriage. Most participants (83.1%) had no previous live births, and a significant proportion had a history of multiple previous abortions. Antiphospholipid syndrome (APLS) was identified in 51.3% of the participants, and specific subgroups of antiphospholipid antibodies (APLA) were found in 42.2% of the cases. In our study 89% pregnant women (137) had live births while 11% pregnant women (17) experienced abortions. Adverse drug reaction included allergic skin reactions in 1.3% of the participants and subcutaneous bruises in 3.2% of the participants. Conclusion: The findings of this study hold the potential to enhance our understanding of the efficacy, safety, and feasibility of LMWH therapy, ultimately offering new avenues for improving reproductive outcomes and alleviating the emotional burden experienced by couples affected by unexplained RFM in India.