A Review of the Correlation between Clinical Diagnosis and Ultrasound Diagnosis in First Trimester Vaginal Bleeding

Author(s):

Chisolum O Okafor, Ikechukwu Innocent Mbachu*, Udobi Samuel Iloraah and Lawrence Ikeako

Background: Bleeding per vaginum is a common first trimester emergency. Accurate diagnosis is very necessary to enable the clinician to institute appropriate and prompt treatment. The implications of false diagnosis include inappropriate treatment and delay in treatment.
Aims and Objectives: The study evaluated the accuracy of clinical diagnosis of first trimester vaginal bleeding according to the cadre of the care giver using ultrasound as a gold standard.
Methods: This was a retrospective study of patients referred to a Specialist Diagnostic Clinic in Nigeria with a history of first trimester bleeding from January 2016 to April 2017. Data was collected from the radiologist’s report and request forms of patients with the above presenting symptoms. The patients’ data retrieved included age, gestational age, parity, clinical and ultrasound diagnosis. All the data collected were analyzed using SPSS version 23 to produce frequency tables and charts. There were cross tabulations to explore relationship between variables at p-value of < 0.005.
Results: A total of 101 patients participated in the study. The mean age was 30.2 years. The most common clinical diagnosis in patients with first trimester bleeding was threatened abortion (65.3%) which was reduced to 34.7% by ultrasound. The overall concordance was 44.55%. The highest concordance of 66.7% was observed in the ectopic pregnancy group. (0%) The highest concordance rate with regards to the referral pattern was recorded in the Obstetrics and Gynecology specialist group (75%) while the least was observed in the patent medicine and unspecified group.
Conclusion: Ultrasound should be done early in patients with first trimester bleeding as this will lead to early definitive diagnosis and commencement of appropriate therapeutic intervention aimed at reduction of mortality and morbidity, reduced hospital stays and cost.