The effect of vaginal bleeding in the first half of pregnancy on fetal outcome is retrospectively analyzed in 523 cases and compared with a control group of 6706. Early-pregnancy bleeding was found to be associated with more preterm deliveries and lower birth weight. The frequency of congenital anomalies and growth-retarded infants was unaffected. Neonatal death and low Apgar scores were seen more often than expected, but stillbirth rates were not significantly increased. These data suggest that vaginal bleeding in early pregnancy is a useful indicator of risk for suboptimal outcome.