Title: Ultrasonographic Evaluation of First Trimester Bleeding and its Clinical Assessment: A Prospective Study
Authors: Manik Mahajan, Poonam Sharma, Sonika Gupta
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.22
Abstract
Introduction: Vaginal bleeding during the first trimester is a common obstetric condition. It is the commonest cause of admissions in the obstetric department and a common reason for ultrasonography (USG) during First Trimester of pregnancy. Approximately 20-25% women in their first trimester complain of vaginal bleeding and it may range from an insignificant episode to life threatening emergency. The major causes are abortion, ectopic pregnancy and molar pregnancy. Clinical history and pelvic examination are inadequate in assessing the cause and prognosis. USG plays a pivotal role in the evaluation of causes of first trimester bleeding, and prognosticate and predict the status of pregnancy.
Aims: To evaluate the role of USG in first trimester bleeding per vaginum and to correlate the findings with clinical assessment
Material and Methods: This hospital based cross sectional study was conducted over a period of 1 year. All the pregnant patients presenting with complaints of bleeding per vaginum in the first trimester of pregnancy were included in the study. Complete clinical evaluation and general physical was performed done to arrive at a clinical diagnosis and patients were then subjected to ultrasound examination. Clinical findings and ultrasound diagnosis were correlated
Results: On USG, Threatened abortion was the commonest cause of bleeding and seen in 55.3% cases. Complete abortion was seen in 15.2% cases while missed abortion and incomplete abortions were seen in 9.1%. Five cases of ectopic pregnancy and 2 cases of complete molar pregnancy were also seen. On clinical examination, threatened abortion was suspected in 74.2% patients while ectopic pregnancy and complete abortions were suspected in 15.2% and 6.1% patients. 56 cases with threatened abortions on USG continued to term gestation with timely and urgent management. Total disparity between clinical diagnosis and USG diagnosis was present in 60.6% cases and clinical diagnosis was confirmed by USG in 82 cases indicating accuracy of clinical diagnosis to be 62.1%.
Conclusions: USG is a valuable and easily available tool in the evaluation of patients with first trimester vaginal bleeding. It is highly accurate in identifying the actual cause of bleeding and guides the clinician in choosing appropriate line of management. Ultrasound is helpful in the decision-making algorithm about the timely intervention and safe continuation of the pregnancy.
References
- Cunningham FG, editor. First trimester vaginal bleeding. In: Williams’s Obstetrics. 21st New York: McGraw-Hill; 2001. p. 866.
- Dogra V, Paspulati RM, Bhatt S. First trimester bleeding evaluation. Ultrasound Q.2005 Jun;21(2):69-85; quiz 149-50, 153-4.
- Yadav V, Santosh, Bharathi. Ultra sonographic evaluation and management of the first trimester bleeding. IOSR Journal of Dental and Medical Sciences. 2015;14(12):43-6.
- Mamatha S, Sagar SG, Manoli N. Ultrasound Evaluation of Vaginal Bleeding in First Trimester of Pregnancy: A Comparative Study with Clinical Examination. Int J Sci Stud 2015;3(7):202-6.
- Morin L, Van den Hof MC; Diagnostic Imaging Committee, Society of Obstetricians and Gynaecologists of Canada. Ultrasound evaluation of first trimester pregnancy complications. J Obstet Gynaecol Can.2005 Jun;27(6):581-91.
- Kumar P, Gupta D, Mukharjee S, Saket R, Sinha P. First Trimester Bleeding: A Diagnostic Dilema-Probing It with Ultrasound. Int J Adv Integ Med Sci. 2017;2(3):117-24.
- Sofat R. Ultrasound evaluation of bleeding in early pregnancy. J Obstet Gynaecol India. 1987;31:344-7.
- Bharadwaj N. Sonography evaluation as an aid in the management of bleeding in early pregnancy. J Obstet Gynaecol India. 1988;38:640-2.
- Gorade TG, Shorothri AN. Ultrasonography in early pregnancy bleeding. J Obstet Gynaecol India. 1991;41:13-6.
- Malhotra J, Saxena K, Malhotra N. Ultrasound evaluation of first trimester bleeding per vaginum. J Obstet Gynecol India. 1987;37:341-3.
- Aronu ME, Okafor CO, Mbachu II, Iloraah US, Ikeako L, Okafor CI. A Review of the Correlation between Clinical Diagnosis and Ultrasound Diagnosis in First Trimester Vaginal Bleeding. Ann Med Health Sci Res. 2018 Mar-Apr;8(2):120-4.