Affiliation:
1. Department of Radiology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
2. Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
Abstract
ABSTRACT
Background:
Vaginal bleeding is the most common cause of presentation at the emergency department in the first trimester. Clinical presentation helps determine the likely cause of first-trimester vaginal bleeding. However, ultrasound imaging is required to reach a definitive diagnosis.
Objective:
To determine the relationship between clinical diagnosis and ultrasonographic findings in women with first-trimester vaginal bleeding.
Methods:
A prospective longitudinal study was conducted on 94 pregnant patients with a history of bleeding per vagina (PV) in the first trimester by using transvaginal ultrasound.
Results:
PV spotting was noted in 64.9% and heavy bleeding in 35.1%. The most common clinically associated symptom was abdominal pain (68, 72.3%), and the least common clinically associated symptom was vesicle expulsion (2.1%). The most common predisposing factor was fever (31, 33.0%). The most frequent clinical diagnosis was threatened abortion (48, 51.1%), and the least common clinical diagnosis was gestational trophoblastic disease (GTD) and inevitable abortion (1, 1.1%). The most common ultrasound diagnosis at the initial scan was incomplete abortion (19.2%), while at follow-up scans, it was threatened abortion (48, 51.1%). The overall concordance between clinical diagnosis and ultrasound was 38.8%, with both complete abortion and GTD showing a concordance of 100%. The least concordance was seen in missed abortions (25%).
Conclusion:
Clinical assessment is insufficient in the identification of the cause of vaginal bleeding due to the overall low concordance rate. A combination of clinical assessment and ultrasonography is required for decision-making in every case.
Reference29 articles.
1. First trimester bleeding evaluation;Dogra;Ultrasound Q,2005
2. First trimester bleeding;Deutchman;Am Fam Physician,2009
3. Sonographic evaluation of first-trimester bleeding;Paspulati;Radiol Clin North Am,2004
4. Ultrasonographic evaluation and management of the first trimester bleeding;Yadav;IOSR Journal of Dental and Medical Sciences,2015
5. Ectopic pregnancy and miscarriage:Summary of NICE guidance;Newbatt;Brit Med J,2012