Background: Vaginal bleeding is the most common reason for consultation in early pregnancy and its effects on pregnancies that survive are still unclear. Objective: Our aim was to study the relationship between bleeding in the first half of pregnancy (BFHP) and foetal outcome (birth weight, gestational age at delivery, and 5th minute Apgar score) in a resource-limited setting. Methods: We conducted a retrospective cohort study in two hospitals in Yaoundé, Cameroon. Medical records of pregnant women who gave birth between January 2020 and May 2023 were reviewed. Participants were categorized into exposed (had vaginal bleeding <20 weeks of gestation) and unexposed groups. Foetal outcome (birth weight, gestational age at delivery, and Apgar score) was the primary outcome. Linear regression analysis was used to examine the contributions of variables to changes in foetal outcome. Results: Of the 200 women included, 35 (17.5%) experienced BFHP. The mean birth weight was significantly lower among women who bled compared to those who did not (2,813 ± 1,008g versus 3,276 ± 566 g; p <0.001). Similarly, the mean gestational age at delivery was smaller in the exposed group (36.3 ± 4.1 weeks versus 38.7 ± 2.4 weeks; p <0.001). The risk of low birth weight was nearly fivefold higher among women with BFHP (RR = 4.7; 95% CI: 2.4–9.3; p <0.001). Among women with BFHP, neither the duration (<1 day or >1 day) nor the gestational age at onset (<10 weeks or >10 weeks) influenced birth weight or gestational age at delivery. While regression analysis suggested a potential decrease in birth weight by 116 grams in the exposed group, this association was not statistically significant (p = 0.326). Conclusion: This study’s findings suggest significant contribution of BFHP, and a history of BFHP in a previous pregnancy, to low birth weight and prematurity. However, further research, with larger samples or a prospective approach, is needed to better elucidate this relationship and the need to an