ULTRASONOGRAPHY

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, NishtarHospital, Multan were included in the study. Non-pregnant patients and patients with vaginal bleeding due to the causeother than conception were excluded. After history, clinical examination and pregnancy test, ultrasonography was donewith abdominal convex probe (3.5 Mhz) and/or vaginal (5 Mhz) probe to every patient. Results: Overall incidence offirst trimester vaginal bleeding was 12.23%. Disparity between clinical and ultrasonic diagnosis was 17.3% in casesof incomplete abortion, 11.6% in cases of inevitable abortion, 9.7% in cases of threatened abortion, 3.8% in cases ofmissed abortion and 1.9% in cases of blighted ovum and 1.9% in cases of molar pregnancy. The confirmation ofdiagnosis after histopathology of surgically obtained specimen revealed least percentage of misdiagnosis on ultrasoundevaluation. While in ectopic pregnancy no disparity found on clinical, ultrasonographic and surgical results, but it wasmisleading as only late cases with ruptured ectopic pregnancy and obvious clinical signs and symptoms were referredto the hospital. Otherwise USG would have shown increased sensitivity and specificity. Conclusion: Study hasconfirmed the superiority of USG scanning over conventional methods in earlier and more precise diagnosis and thusbetter treatment of patients having first trimester vaginal bleeding. It is more accurate, safe, non-invasive and quick indiagnosis and management. It prevents from undue surgical intervention as well as undue delay in surgery whenrequired. Once bleeding has occurred repeat pregnancy test should he ignored and better not done at all. Thus USGshould he an important diagnostic tool in every emergency unit but importance of clinical diagnosis cannot beoverlooked.