Role of Pelvic Sonography in First Trimester Bleeding

Abstract

OBJECTIVE:To confirm the clinical diagnosis in patient with first trimester bleeding. To evaluate the role of pelvic ultrasound, in management of first trimester bleeding. To correlate the outcome of pregnancy, with fetal activity seen on pelvic ultrasound. METHODS: Study includes all Obstetric cases attending Bhabha Atomic Research Centre and Hospital with history of bleeding per vaginum in first trimester of pregnancy during the study period October 2011 to September 2013. RESULT: In our study we have evaluated 100 cases of bleeding in the first trimester of pregnancy to know the role of ultrasound examination. On mere clinical examination, it was not possible to diagnose many cases correctly. There was a disparity of 72% between clinical and sonological diagnosis. Out of 86 cases clinically diagnosed as threatened abortion only 50 cases were confirmed as threatened abortion by ultrasonography. Rest 36 cases were misdiagnosed clinically. Sonographically diagnosed 50 cases were followed and all 50cases continued as normal pregnancy. 8 cases of these 50 threatened abortions had chorionic hemorrhage in ultrasonography findings, but all 8 cases also continued as normal pregnancy. These 36 clinically misdiagnosed cases were diagnosed correctly on ultrasonography as 12 cases of complete abortion, 4 cases of incomplete abortion, 1 case of inevitable abortion, 11 cases of missed abortion, 1 case of complete mole and 7 cases of blighted ovum. 1 cases of complete abortion was diagnosed by sonography only. 3 cases were clinically diagnosed as incomplete abortion, but only 1 was confirmed on sonography, rest 2 cases were case of missed abortion and blighted ovum. All 8 cases of blighted ovum was ultrasonography diagnosis only. None of them could be diagnosed clinically. 3 cases of ectopic pregnancy were diagnosed clinically and also confirmed on ultrasonography. 1 case of complete mole was an ultrasonography diagnosis only. CONCLUSION: Bleeding per vaginum in the first trimester is one of the most common causes for the majority of emergency admissions to the obstetrics department and also vaginal bleeding is most frequent indication of first trimester ultrasonography. The common causes of bleeding during first trimester include abortions, ectopic pregnancy and molar pregnancy. Ultrasound is a non-invasive, non-ionizing and easily available method of investigation to assess the patients with first trimester bleeding which is highly accurate in diagnosing the actual causes of bleeding and guides the clinician in choosing the appropriate line of management and prevents mismanagement of the cases. Ultrasound can assess some findings which are helpful in predicting the prognosis of the pregnancy. Life threatening emergency like ectopic when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status.

Study of Perinataloutcome in Patients Presenting With First Trimester Bleeding

“… Molar pregnancy: In our study, molar pregnancy was present in 1.5% of patients. This is in accordance with the study of Barik et al, (2016) and Kurmi et al, (2015) in which molar was seen in 2.12% and 1% of cases respectively. In our study, 75.5% continued pregnancy in which preterm delivery occurred in 21.5% and full term delivery occurred in 78.5% of patients.…”

“… Ectopic: In our study, ectopic was found in 5% of patients. In study conducted by Barik et al, (2016) and Kurmi et al, (2015), ectopic was 3.19% and 3 % respectively.  Molar pregnancy: In our study, molar pregnancy was present in 1.5% of patients.…”

Role of ultrasonography in cases of first trimester vaginal bleeding and its correlation with clinical findings: A prospective observational study

“…Remaining cases were 14 incomplete abortion, 14 an embryonic gestation, 15 missed abortion, 3 complete abortion, and 7 ectopic and 3 molar pregnancy. Deepti Kurmi et al [14] , in her study as shown in table 3, out of 86 cases ultrasonography confirmed 50 cases as threatened abortion and 12 cases as complete abortion, 4 cases incomplete abortion, 11 cases of missed abortion,1 case of inevitable abortion, 7 cases blighted ovum,1 as hydatidiform mole. In our study, Figure 2 shows positive predictive value of clinical diagnosis for threatened abortion is 60.9%, missed abortion in present study is 31.2%, incomplete abortion 44.4%, complete abortion 50 %, ectopic pregnancy 100% & hydatidiform mole 100% and comparable with Deepti kumara et al…”

“…In present study, the pregnancy outcome after doing ultrasonography in 180 cases of first trimester vaginal bleeding are viable pregnancy was seen in 105 (58.33%) cases, nonviable pregnancy in 67 cases, 6 cases of ectopic gestation and 2 cases of hydatidiform mole. [15] 1986 64% 36% 0 0 0 Schaubergeret al [16] 2005 44% 33% 5% 0 18% DeeptiKurmiet al [14] 2015 50% 46% 3%% 1% 0 Shivanagappaet al [11] 2015 Stabile et al [15] viable pregnancy was seen in 64% cases, nonviable pregnancy was seen in 36% cases. Deepti Kurmi et al [14] , viable pregnancy was seen in 50 (50%) cases.…”

“…[15] 1986 64% 36% 0 0 0 Schaubergeret al [16] 2005 44% 33% 5% 0 18% DeeptiKurmiet al [14] 2015 50% 46% 3%% 1% 0 Shivanagappaet al [11] 2015 Stabile et al [15] viable pregnancy was seen in 64% cases, nonviable pregnancy was seen in 36% cases. Deepti Kurmi et al [14] , viable pregnancy was seen in 50 (50%) cases. Non-viable pregnancy was seen in 46% cases, 3% cases of ectopic pregnancy and 1% case of complete mole.…”