Ultrasonic assessment of early pregnancy bleeding.

Thesis Report.

ABSTRACT:

Objective of this study was to assess the role of ultrasonography in diagnosing normal and abnormal pregnancy whenever women presented with bleeding in pregnancy up to 20 weeks of gestation. The specific objectives were to assess fetal viability, to note gestational age at the star of vaginal bleeding and to identify features that indicate imminent fetal death.

Methods: This study was conducted in Maternity Hospital Thapathali and Teaching Hospital, Kathmandu, Nepal from 2059-4-1 to 2059-10-1. Total 100 cases were enrolled in the study were pregnant women of all ages and parity with amenorrhoea up to 20 weeks and vaginal bleeding. The gestational age at first bleeding episode, amount and duration of bleeding, history of expulsion of product of conception were noted. The findings of clinical examination and ultrasonic findings were correlated. The ultrasound scanning was done either by transabdominal or transvaginal probe. On USG scan - i. number of sac, mean sac diameter, ii. yolk sac, iii. fetal pole, iv. presence of cardiac activity, v. presence of subchorionic hematoma, and findings suggestive of ectopic pregnancies were noted.

Results: After ultrasonic evaluation of 100 cases of vaginal bleeding, 30 cases were diagnosed to be intrauterine live pregnancy. Rest two third cases were abnormal pregnancies, which comprised in descending order to be Missed abortion (18), incomplete abortion (18), ectopic pregnancy (12), and molar pregnancy (11) complete abortion (6) and blighted ovum (5). Intrauterine and extra uterine gestation was 88 and 12 respectively. Ultrasound provided correct diagnosis in 34 cases clinically diagnosed as threatened abortion inclusive of 5 cases of blighted ovum and a case of ectopic pregnancy. It also provided correct diagnosis in 3 cases of incomplete abortions that were diagnosed as complete abortions (2) and molar (1). The number of complete abortion was increased 1-6, also the missed abortion 10-18; the number of incomplete abortion also 8-18; molar from 6-11 and ectopic 11-12. There was an additional diagnosis of blighted ovum (5). 61 cases presented in the first trimester and 39 cases in the early second trimester (13-20 weeks). Gestational age at first bleed was maximum below 12 weeks for ectopic, blighted ovum; but above 12 weeks for missed, incomplete, complete abortions and H.mole. A case, out of thirty cases intrauterine live pregnancy showed signs of imminent fetal death i.e oligohydraminos and aborted spontaneously. In missed abortion I case had subchoronic hematoma measuring 2.5x1.5xx1.3 cm, which could be correlated to fetal loss.

Conclusion: USG scan was found to be very helpful in our study because it correctly diagnosed 34 abnormal pregnancies which could have been observed as threatened abortion for long period had there been no ultrasonic assessment. Moreover an ectopic pregnancy could have been missed which requires quick interventions. USG in addition diagnosed 2 cases of clinically judged incomplete abortion as complete, saving evacuation in both these cases. Except for a case of missed abortion, which was found to be molar during evacuation confirmed also histopathologically; ultrasonography facilitated in obtaining a correct diagnosis in 99% cases of early pregnancy bleeding enabling timely intervention for those who required immediate surgical procedure or follow up of the normal pregnancy.

Key words: Ultrasonography in early pregnancy bleeding. abnormal pregnancy bleeding, Fetal viability.

Eng.