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.