A PROSPECTIVE CLINICAL STUDY OF ROLE OF ULTRASOUND IN FIRST TRIMESTER VAGINAL BLEEDING

Abstract

Introduction: Vaginal bleeding is one of the most frequent and potentially serious causes that necessitate emergency consultation during pregnancy. The first trimester is a dynamic period that encompasses ovulation, fertilization, implantation, and organogenesis. Nearly 20-25% of pregnant women experience some degree of bleeding during the early months of gestation.1
Materials and methods: The study includes all obstetric cases attending department of Obstetrics and Gynecology, Tagore Medical College, Chennai with history of bleeding per vaginum in first trimester from January 2024 to December 2024. Sample size of 200 cases who presented with history of bleeding in first trimester of pregnancy have been included. It is a hospital based prospective study of patients who present with bleeding per vaginum in the first trimester of pregnancy during the study period. Clinical details like age, parity, obstetric history, personal history, medical history, past history, menstrual history and details of present pregnancy in terms of period of amenorrhoea at the time of first episode of bleeding, amount and duration of bleeding whether associated with pain abdomen or not and history of expulsion of fleshy mass
/clots were noted. Clinical examination including general physical examination and pelvic examination was done to arrive at a provisional clinical diagnosis.
Results: Total obstetric cases was 8416, out of which 200 cases had bleeding per vagina in first trimester (2.37%). The above table shows, majority of them in the age group of 21-25 years constitutes 48%. 60 cases (30%) in 18-20 years, 28 (14%) in 26-30 years, 16 (8%) in 31-35 years. The mean age was 23 years. In the present study, 66 (33%) primigravida and 134 (67%) multigravida. Majority of cases 144 (72%) had uterine size <10 weeks and 32 (16%) between 10- 12 weeks. Cervical os was open in 62(31%) cases and closed in 138 (69%) cases. Fornices was free in 184 (92%) cases and tender in 16 (8%) cases. In the study as per clinical diagnosis, majority of cases, 98 (49%) cases were clinically diagnosed as threatened abortion, 52(26%) cases as incomplete abortion, 18 (9%) cases as missed abortion, 8 (4%) cases as ectopic pregnancy, 14 case as complete abortion, 8 cases as inevitable abortion and 2 cases as molar pregnancy. Conclusion: In the present study, USG played a very important role in the diagnosis of cause of first trimester bleeding. It can diagnose threatened abortion positively. Missed abortion, anembryonic gestation and incomplete abortion, ectopic gestation and molar pregnancy are reliably diagnosed. Patient with complete abortions were accurately identified, so that unnecessary curettage was avoided with a consequent reduction in morbidity. Therefore ultrasound diagnosis in first trimester bleeding is a key diagnostic tool. Ultrasonography has helped in establishing the correct diagnosis of clinically misdiagnosed cases, confirm the diagnosis in the others and provide the most appropriate management in all of them.