Objective：To investigate the effect of early intrauterine hemorrhage diagnosed by ultrasound on pregnancy outcome of elderly pregnant women. Method：From June 2022 to June 2023, 80 elderly pregnant women with intrauterine hemorrhage who were first found by ultrasound examination in our hospital were selected as the research objects. According to the pregnancy outcome, they were divided into normal pregnancy delivery group (40 cases) and adverse pregnancy outcome group (40 cases). The baseline data and ultrasound examination results of the two groups were compared, and the effect of early intrauterine hemorrhage diagnosed by ultrasound on pregnancy outcomes was analyzed. The relationship between early intrauterine hemorrhage diagnosed by ultrasound and pregnancy outcomes and the application efficacy were analyzed. Result：The gestational age at first diagnosis, the proportion of anterior placental wall, the proportion of hematoma under the placenta, the volume of the first hematoma, the proportion of uterine contraction, and the RI value of the adverse pregnancy outcome group were higher than those of the normal pregnancy and delivery group, and the proportion of posterior placental wall, the proportion of hematoma under the chorionic membrane, EDV value, and PSV value were lower than those of the normal pregnancy and delivery group. Logistic regression analysis showed that gestational age at first diagnosis, placenta location, hematoma location, first hematoma volume, uterine contraction, EDV, PSV and RI were risk factors for adverse pregnancy outcomes in elderly pregnant women with intrauterine hemorrhage (P<0.05). Pearson correlation analysis showed that EDV was negatively correlated with gestational age at first diagnosis and hematoma volume at the first time (r=-0.621, -0.603). PSV was negatively correlated with gestational age at first diagnosis and hematoma volume at first diagnosis (r=-0.611, -0.593). RI was positively correlated with gestational age at first diagnosis and volume of hematoma at first diagnosis (r=0.732, 0.704). The ROC curve showed that the area under the curve (AUC) of early uterine hemorrhage volume diagnosed by ultrasound to evaluate the adverse pregnancy outcomes of elderly pregnant women was 0.861 (95%CI: 0.776-0.946), and the sensitivity and specificity were 90.00% and 92.50%, respectively (P<0.05). Conclusion：Gestational age at first diagnosis, placenta location, hematoma location, first hematoma volume, uterine contraction, EDV, PSV and RI are risk factors for adverse pregnancy outcomes in elderly pregnant women with intrauterine hemorrhage. Ultrasound diagnosis of early intrauterine hemorrhage volume has certain application value in evaluating adverse pregnancy outcomes in elderly pregnant women, which plays an important role in improving pregnancy outcomes.