ROLE OF USG IN EVALUATION OF FIRST TRMESTER BLEEDING PERVAGINUM IN A RURAL TERTIARY CARE HOSPITAL IN MAHARASHTRA, INDIA: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

BACKGROUND:

           Vaginal bleeding in the first trimester of pregnancy is a common obstetric problem.The common causes of bleeding during first trimester include various types of abortions, ectopic pregnancy & molar pregnancy. Clinical history & pelvic examination are inadequate in assessing the cause & prognosis.

OBJECTIVE of this study is to evaluate the role of USG in the evaluation of patients with first trimester bleeding & to prognosticate & predict the status of abnormal pregnancies.

METHODS:  The study was carried out on 50 pregnant women who presented with bleeding per vaginum in first trimester of pregnancy visiting obstetrics & gynaecology department . The patients were included on the basis of clinically suspected first trimester bleeding (< 12 completed weeks). All non-obstetrical causes of vaginal bleeding & those with more than 12 completed weeks of gestation were excluded from the study. All patients referred to the Dept of Radio diagnosis with clinically suspected first trimester bleeding were evaluated with clinical history, clinical examination & ultrasonography.

RESULTS:

            Of the fifty cases of first trimester bleeding, 26 cases were diagnosed as threatened abortion clinically, out of which only 12 cases were confirmed. USG examination confirmed 12 cases of clinically suspected threatened abortions & aids in correctly diagnosing 8 cases which were missed on clinical examination. 12 cases out of 18 threatened abortions continue to term gestation with a successful outcome of 66%. All cases of threatened abortion (n=18), incomplete abortion (n=10), missed abortion (n=4), ectopic (n=4), inevitable abortion (n=4), blighted ovum (n=2), & HM (n=2), were correctly diagnosed on USG. 48 out of 50 cases were correctly diagnosed on USG compared to 18 out of 50 cases on clinical diagnosis with a disparity of 64%. 4 out of 5 proved ectopic pregnancies were correctly diagnosed both on USG & clinical examination.

CONCLUSION:

USG is a non-invasive, non-ionizing, without any proved harmful effects on the developing fetus & easily available method of investigation to assess the patients with first trimester bleeding which is highly accurate in diagnosing the actual causes of bleeding & guides the clinician in choosing the appropriate line of management & prevents mismanagement of the cases. In the present study, 48 out of 50 cases were correctly diagnosed on USG compared to 18 out of 50 cases on clinical diagnosis with a disparity of 64%.