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|Year : 1992 | Volume
| Issue : 3 | Page : 115-6
Role of ultrasonography in early pregnancy complications.
LJ Iyer, M Bhattacharya
Dept of Gynaecology and Obstetrics, KEM Hospital, Parel, Bombay, Maharashtra.
L J Iyer
Dept of Gynaecology and Obstetrics, KEM Hospital, Parel, Bombay, Maharashtra.
Source of Support: None, Conflict of Interest: None
Two hundred patients in the first trimester of pregnancy presenting with complications were evaluated both clinically and by ultrasonography. The ultrasonographic interpretations were classified as either confirmatory, diagnostic or misleading based on their correlation with the clinical diagnosis. It was observed that in 51% cases sonography was confirmatory, in 41% diagnostic and in 8% misleading. Used judiciously, ultrasonography provides a reliable aid in management of early pregnancy complications.
Keywords: Abortion, Spontaneous, ultrasonography,Comparative Study, Female, Hospitalization, Human, Pregnancy, Pregnancy Complications, ultrasonography,Pregnancy Complications, Neoplastic, ultrasonography,Pregnancy Trimester, First, Pregnancy, Ectopic, ultrasonography,
|How to cite this article:|
Iyer L J, Bhattacharya M. Role of ultrasonography in early pregnancy complications. J Postgrad Med 1992;38:115
The first trimester of pregnancy is an important period often fraught with complications like bleeding and pain, leading to severe apprehension in the mother, Prior to the advent of ultrasonography (USG), all these patients were empirically managed only clinically, many a times along the wrong line. Ultrasonography however, has revolutionised the management in such cases of early pregnancy complication and thus immediate conclusive therapy can be instituted in almost all cases.
A random study of 200 hospitalised patients in the first trimester of pregnancy with complications was undertaken, using a real time ultrasonic scanner. History taking, physical and pelvic examination were done by the obstetrician. The diagnosis established by the sonographic evaluation was classified into three categories. It was labelled as 'confirmatory' if the clinical diagnosis was reaffirmed. If the actual status of the patient was established by the ultrasound examination, the interpretation was labelled as 'diagnostic'. If the ultrasonographic interpretation did not reveal the actual status of the patient, it was classified as 'misleading'.
The subsequent clinical examination findings and operative procedures like dilatation and curettage (D & C), laparoscopy or exploration were noted.
The various diagnoses reached with ultrasound are shown in Table -1. Of the 74 patients clinically diagnosed as threatened abortions, only 36 showed ultrasonographic findings of the same. USG was diagnostic of a non-viable pregnancy in the remaining 34 of these patients. Eight of the 40 patients suspected to have a missed abortion were actually diagnosed as normal viable pregnancies and 2 cases had an empty non-pregnant uterus. In 2 patients clinically diagnosed as complete abortion, significant products of conception were seen on USG. Twelve of the 18 cases suspected to be having a delayed period turned out to be either missed abortion (n=6) or incomplete abortion (n=6). Six of the 12 cases with suspected vesicular mole, 6 patients with suspected ectopic pregnancy and 2 with fibroid uterus were diagnosed on USIG as having normal viable pregnancies. Twelve of the 26 cases with clinical suspicion of ectopic gestation could also be proved otherwise by sonography.
Ultrasonography has opened new dimensions in early pregnancy complications so that specific treatment, medical or surgical, can be immediately instituted. Accurate diagnosis of the nature of the pregnancy (viable or non-viable) can avoid unnecessary hormonal treatment and prolonged hospitalisation. It also indicates the need for a dilatation and currettage by diagnosing retained products in the uterine cavity. Ultrasonographic examination should be done at the earliest possible period so as to confirm the clinical findings. As shown in our study, the clinical findings were confirmed by ultrasonography in only 51% of cases, while in 41 % cases, it played the diagnostic role. Thus, overall accuracy is nearly 92%, which almost doubles the clinical accuracy. Also, this means that 41 of cases would have been wrongly managed in the absence of USG. These results compare favourably with a similar study by Duff who could confirm the clinical findings in only 50% cases.
In cases of abortion, ultrasound examination provides a good index for evacuation. Currettage is necessary if residual contents are seen but not when the uterus though bulky appears empty. Romero and his colleagues used sonographic monitoring to guide the performance of post-abortion uterine curettage. It ensures completeness of the procedure and prevents uterine perforation during the procedure. Recently, Rajan and Rajan, have stated the invaluable role of ultrasonography in first trimester bleeding. A normal pregnancy with excellent chances for a viable birth could be differentiated using USG from a pathological pregnancy, which warrants an immediate termination. Also, they have reaffirmed the need for ultrasonography in very early pregnancy complications and have observed excellent prognosis in over 96% of subjects in whom a normal gestational sac and a live fetus were seen.
The sonographic landmarks of the first trimester pregnancy have been well recognised and they include identification of the gestational sac, fetal pole, fetal cardiac activity, movements, yolk sac and the amnion. The invaluable role of these landmarks, the gestational sac and fetal biometry in diagnosing pathological pregnancies and predicting the pregnancy outcome has been clearly documented by Decherney et al.
Kobayashi et al have reported overall false positive and false negative rate of 25.6% in ultrasonographic diagnosis of ectopic gestation. It is helpful in locating the pregnancy within the uterus, thus usually being contradictive of the diagnosis of ectopic gestation. According to Kadar et al the most reliable criteria for diagnosing ectopic pregnancy are based on the sonographic appearance of the uterus in the presence of a positive urine pregnancy test along with serum ?-HCGi Values.
From our study, it appears that USG helps to establish the type of pathology in early pregnancy complication. However, a close communication between the sonologist and obstetrician is necessary. The investigation should be viewed as an extension and amplification of the pelvic examination and not the substitute for obstetric history and clinical examination.
We thank the Dean of King Edward Memorial Hospital for allowing us to publish the hospital data.
| :: References|| |
Duff GB. Prognosis in threatened abortion: a comparison between predictions made by sonar, urinary hormone assays and clinical judgement. Br J Obstet Gynaecol 1975; 82:858-862. |
|2.||Romero R, Copel J, Phillippe JY, Reece AE, Reiss R, Hobbins JC. Sonographic monitoring to guide the performance of post-abortion uterine curettage. Am J Obstet Gynaecol 1985; 151:51-53. |
|3.||Rajan R, Rajan V. Ultrasonography in first trimester bleeding. J Obstet Gynaecol India 1987; 37:457-461. |
|4.||Rajan R, Rajan V. Early pregnancy complications in three different categories of patients, a sonographic study. J Obstet Gynaecol India 1987; 37:463-467. |
|5.||DeCherney AH, Romero R, Polan ML. Ultrasound in reproductive endocrinology, Fertil Steril 1982; 37:323-323. |
|6.||Kobayashi M, Hellman LM, Fillisti LP. Ultrasound, an aid in the diagnosis of ectopic pregnancy. Am J Obstet Gynaecol 1969; 103:1131-1140. |
|7.||Kadar N, Devore G, Romero R. Discriminatory HCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynaecol 1981; 58:156-161.
[Table - 1]
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