Role of ultrasonography in diagnosing causes of first trimester vaginal bleeding: A cross-sectional study
During the first trimester of pregnancy, approximately 25% of women experience bleeding. The differential diagnosis for bleeding includes threatened abortion, early pregnancy loss, and ectopic pregnancy. Pain and heavy bleeding increase the risk of miscarriage. Ultrasonography is pivotal in pinpointing underlying factors and can aid in diagnosing the source of first trimester bleeding, facilitating suitable treatment. Within this background, this study investigated the causes of first trimester bleeding using ultrasound and to assess the various forms of abortion in this population.
After ethical clearance, cross sectional study was conducted on 75 pregnant women with clinically suspected 1st trimester bleeding. The gravida status, duration of amenorrhoea and duration of bleeding was monitored among the subjects. The selected subjects were then subjected to trans abdominal and if required transvaginal ultrasound. Clinical findings and ultrasound diagnosis were correlated. The data was entered into Microsoft excel and analysed using statistical software.
Mean age of the subjects 25.97 years, Age group ranged from 18 to 35 years, with 52 being multigravida and 23 primigravida. Threatened abortion was the most common cause, accounting for 23 (30.7%), followed by incomplete abortion 12 (16%) and missed abortion 11(14.6%). Other causes were total abortion (9.3%), embryonic pregnancy (13.4%), ectopic pregnancy (5.3%), and molar pregnancy (5.3%). A discrepancy was seen between clinical diagnosis and ultrasonography examination.
It has been repeatedly demonstrated that ultrasound, with its comparatively better safety profile, is a useful means of obtaining high-quality dynamic images of obstetrical complications. Ultrasound is a sensitive and specific non- invasive diagnostic tool in the evaluation of first trimester bleeding. First-trimester ultrasounds are most frequently performed to determine the location, viability, and accurate gestational age of the pregnancy. Bleeding per vaginum is the most common problem that occurs during the first trimester of pregnancy which has varying morbidity based on the cause and severity of the different findings. Clinical diagnosis often presented with dilemma and discrepancies in identifying the causes. Ultrasound further helps to accurately classify as viable and nonviable.
When there is a substantial discrepancy between clinical and ultrasonography diagnoses in clinical practice, it is imperative to place more weight on the findings of more precise and objective diagnostic techniques, such as ultrasound. This makes it possible to accurately identify the underlying cause and guarantees that the patient will receive the right care according to their particular needs. Because home pregnancy tests are so widely accessible, women can now determine whether or not they are pregnant before visiting a doctor for any pregnancy-related issues. It's crucial to understand, though, that a positive pregnancy test does not always imply a healthy pregnancy. It may occasionally indicate an unviable pregnancy, such as an ectopic pregnancy or miscarriage, which can carry significant hazards to the woman's life and health.
Source: Gomes et al. / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):342–348
