ULTRASONOGRAPHY

ITS VALUE IN THE MANAGEMENT OF FIRST TRIMESTER VAGINAL BLEEDING

Abstract

Objective: To find the value of ultrasound in the management of first trimester vaginal bleeding.
Material and Methods: All patients reporting with vaginal bleeding in obstetrics and gynaecology Unit-III, Nishtar
Hospital, Multan were included in the study. Non-pregnant patients and patients with vaginal bleeding due to the cause
other than conception were excluded. After history, clinical examination and pregnancy test, ultrasonography was done
with abdominal convex probe (3.5 Mhz) and/or vaginal (5 Mhz) probe to every patient. Results: Overall incidence of
first trimester vaginal bleeding was 12.23%. Disparity between clinical and ultrasonic diagnosis was 17.3% in cases
of incomplete abortion, 11.6% in cases of inevitable abortion, 9.7% in cases of threatened abortion, 3.8% in cases of
missed abortion and 1.9% in cases of blighted ovum and 1.9% in cases of molar pregnancy. The confirmation of
diagnosis after histopathology of surgically obtained specimen revealed least percentage of misdiagnosis on ultrasound
evaluation. While in ectopic pregnancy no disparity found on clinical, ultrasonographic and surgical results, but it was
misleading as only late cases with ruptured ectopic pregnancy and obvious clinical signs and symptoms were referred
to the hospital. Otherwise USG would have shown increased sensitivity and specificity. Conclusion: Study has
confirmed the superiority of USG scanning over conventional methods in earlier and more precise diagnosis and thus
better treatment of patients having first trimester vaginal bleeding. It is more accurate, safe, non-invasive and quick in
diagnosis and management. It prevents from undue surgical intervention as well as undue delay in surgery when
required. Once bleeding has occurred repeat pregnancy test should he ignored and better not done at all. Thus USG
should he an important diagnostic tool in every emergency unit but importance of clinical diagnosis cannot be
overlooked.