Sonographic findings in patients with first trimester bleeding and related associations in Nairobi

Abstract

INTRODUCTION Ultrasound imaging plays a major role in evaluation of pregnancies especially in the first trimester. Vaginal bleeding in early pregnancy is a relatively common presentation in the acute gynaecological setting, and ultrasonography remains the safest and fastest way of evaluating these patients. OBJECTIVE The aim of the study was to determine the ultrasound findings inpatients presenting with vaginal bleeding in the first trimester and their proportions. MATERIALS AND METHODS A cross-sectional descriptive study carried out at the University of Nairobi, Department of Diagnostic Imaging and Radiation Medicine (DDIRM, UON) and at Kenyatta National Hospital (KNH). All Patients presenting to the radiology department for ultrasound due to vaginal bleeding in the first trimester, between April and December, 2013, were evaluated with a pelvic ultrasound, either transabdominal, transvaginal or both. A data collection sheet was used to record the pelvic sonographic findings and possible predisposing factors associated with the vaginal bleeding. The data was analysed using the Stata computer software package and the results presented in the form of tables, pie charts and bar charts. RESULTS A total of 231 patients were recruited into the study. The age range was 16 – 47 years with a mean of 27.83 years and a median of 27 years with a standard deviation of 5.686. Most patients were in the 26 to 35 year age group (133 cases; 57.6%). All 231 patients had abnormal findings on ultrasound, but 6 of them had more than one finding, giving a total of 237 findings. The commonest finding was incomplete abortion accounting for 38.7% of cases, followed by ectopic pregnancy accounting for 28.1%, while the least common finding was uterine fibroids in pregnancy accounting for 0.4%. First trimester bleeding was associated with a high rate of pregnancy loss with 206 of the patients (89.2%) having pregnancy loss. CONCLUSION Vaginal bleeding during the first trimester of pregnancy was associated with high rates of pregnancy failure in the emergency setting, with incomplete abortion and ectopic pregnancy being common sonographic findings. One should therefore have a high suspicion index for these conditions and apply appropriate investigative procedures and management.