INTRODUCTION
Bleeding or spotting from the vagina during pregnancy can be very distressing to the woman and her family, and for good reason. It could be life-threatening.
There are many causes of bleeding from the vagina in the first trimester, ranging from implantation bleeding, threatened abortion, and inevitable abortion to incomplete abortion. It could also be due to a pregnancy occurring outside the womb (an ectopic pregnancy).
In the second and third trimesters of pregnancy, common causes of bleeding per vagina include; an abnormally located placenta that is close to or covering the cervix (placenta praevia) and premature separation of the placenta from the wall of the uterus( abruptio placenta).
Other causes may include;coexisting fibroids, cervical erosion, co-existing coagulopathy etc
THE ROLE OF ULTRASOUND
Ultrasound is a medical imaging modality that uses high frequency sound to non-invasively visualise and examine organs within the body. It is available, relatively cheap and does not involve ionizing radiation.
However, it is heavily operator-dependent.
The role of ultrasound in bleeding per vagina in pregnancy includes answering the following questions?;
Diagnosis of pregnancy: Is the woman actually pregnant or not?
4weeks GA
5eeeks GA
If yes, what is the gestational age? Is it viable?
8weeks GA
11weeks GA
Location of the pregnancy: Is the pregnancy within the uterus or not? If it's an ectopic pregnancy, where is it?
Ectopic pregnancy
Ectopic pregnancy
Heterotopic pregnancy
Is There Harmoperitoneum? Is The Fetus Still Viable?
Haemoperitoneum
Is there an abortion? In threatened abortion, there maybe be subchorionic bleed, if there is, how much of it? Is the internal cervical os open?, this will make it an inevitable abortion.
Are there co-existing fibroids?If yes, where are they located?
Uterine fibroid coexisting with early cyesis.
Non-pedunculated subserous fibroid.
Localise the placenta.Is there placenta praevia?If yes, what is the grade?
Major Placenta praevia
Major placenta praevia(Type 4)
Vasa praevia;Vasa praevia is a rare but potentially catastrophic cause of antepartum haemorrhage.
Is there abruptio placenta?
Abruptio placenta
How is the baby doing? Is the fetal heart beating? What is the heart rate?
Answering the questions above and more is the role of ultrasound in the management of antepartum haemorrhage. It provides guidance and direction as it aids the judgement of the clinician or obstetrician.
Ultrasound in the hand of a skilled operator is an invaluable tool in the management of antepartum haemorrhage.
Dr Kester Efugh
MBBS,DFM
