Endovaginal versus transabdominal assessment of bleeding during early pregnancy

ABSTRACT

This study was aimed at evaluating the accuracy, diagnostic and prognostic values of vaginal ultrasound as compared to abdominal ultrasound in women with vaginal bleeding in early pregnancy. A prospective study of 196 women consecutively were admitted to Northern Area Armed Forces Hospital. Saudi Arabia, with vaginal bleeding and provisionally diagnosed as threatened abortion or suspected ectopic pregnancy. Both transabdominal and vaginal ultrasound examinations were done to all eases and the results were compared to the clinical pregnancy outcome and statistically analyzed. Fifteen non pregnant cases were excluded from the study. Among 181 women of the study, 111 cases [16.3%] had clinically intact pregnancy. Vaginal US diagnosed an intrauterine pregnancy with fetal pole and cardiac activity in 111 cases at first examination while abdominal US reported that in 97 eases only. The difference was statistically significant. Anembryonic pregnancy was suspected in 38 cases by abdominal US, while vaginal US detected fetal pole in 15 out of these cases and diagnosed anembryonic pregnancy in 23 cases [P< 0.05]. Missed abortion was suggested in 23 cases with abdominal US, while vaginal US detected cardiac activity in larger number of cases and diagnosed missed abortion only in 11 cases [P< 0.05] and coinciding with the clinical outcome. Ectopic pregnancy was surgically diagnosed in eight cases who were vaginally diagnosed, while abdominal US strongly suggested ectopic in three cases out of eight, the difference was highly significant [P< 0.01]. There were no significant differences in diagnosis of complete abortion, incomplete abortion and hydatiform mole with the use of either abdominal or vaginal US. Vaginal scan is an accurate, informative diagnostic measure in early pregnancy complications. It has a higher diagnostic and prognostic values compared to abdominal scan in pathological diagnosis of intact pregnancy, missed abortion, anembryonic and ectopic pregnancies. It is recommended to he carried out at the time of pelvic examination when the clinical indication was first encountered