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Transvaginal Ultrasonography in First Trimester of Pregnancy & its Comparison with Transabdominal Ultrasonography

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Author(s): Aneet Kaur | Amarjit Kaur

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 255;
Date: 2011;
Original page

Keywords: TransabdominalUSG | TransvaginalUSG | 1st Trimester | Gestational Sac | Evaluation | Comparison

ABSTRACT
Background: Ultrasonography being non-invasive, safe and without hazards of radiation, it has gainedwide acceptability, as an integral part of basic investigative procedures. Transabdominal scanning is usedpredominantly in the second and third trimesters of gestation. Its use in first trimester is relatively limitedand mostly diagnostic in nature. The introduction of the higher frequency transvaginal probe, with itshigher resolution of images, opens new possibilities to study early gestation. So it is an attempt to studyTransvaginal/ Transabdominal Ultrasonography in 1st trimester of pregnancy and its comparison.Aims and Objectives: Examination of pregnant women in the first trimester with transvaginalultrasonography with the aim to study various foetal development markers e.g. gestation sac, yolk sac,foetal heart motion, CRL length and foetal anatomy in both normal and abnormal pregnancies.• To assess the relative merits and demerits of transvaginal ultrasonography in comparison withtransabdominal technique.Material and Methods: The study will be conducted on fifty females patients during the first trimesterof pregnancy. The study population will consist of both normal and abnormal pregnancies. These patientswill be included on the basis of suspicion of or proven pregnancy of duration up to 12 weeks from LMP.The evaluation of the patients will include the following:• Record of patients obstetrical history and clinical examination.• Record of pregnancy test and relevant investigations.• Ultrasonic examination of pregnancy (a) transabdominal ultrasound scanning will be done withmoderately distended bladder by using real time scanners with low frequency probe (3/3.5 MHz)b) Transvaginal Sonography• It will be done with real time sector scanner using high frequency endovaginal probe ( 5/ 7.5MHz), after the patient voids urine.Results: In the present study of 46 normal intrauterine pregnancies, TVS showed additional informationin 36 patients (78.3%) as compared to TAS, in detection of gestation sac, yolk sac, double bleb sign orbetter visualization of embryonic anatomy. In the abnormal pregnancy (n=17), TVS provided moreinformation in 11 cases (64.9%), which included detection of embryonic demise, yolk sac, double blebsign, or sub-chorionic haemorrhage. Regarding ectopic gestations (n=7), TVS gave additional informationin 5 cases (71.4%) which included detection of ectopic fetal pole, yolk sac, decidual cast, adnexal massand fluid in cul de sac. In 2 cases, both TAS and TVS gave equal information. However in 2 cases TASdemonstrated the extent of intra-abdominal fluid better than TVS.Conclusion: In the last two decades, ultrasound has become an essential diagnostic modality in the fieldof obstetrics for evaluation of pregnancy and foetal well being. However the standard transabdominalscanning (TAS) using lower frequencies with relatively poorer axial resolution is unsuitable for imaging first trimester conceptus. The introduction of higher frequency transvaginal probe which can be placedclose to the pelvic orgaqns and has better resolution has opened entirely new possibilities to study indetail the early gestation.Not many workers have compared various parameters of early pregnancy (normal as well as abnormal) bytransvaginal and transbdominal sonography on the same patients. So, it was thought that it would behighly imperative to study both these techniques on the same patients to rule out any subjectivity andexaminer's bias.To conclude TVS reliably identified normal and abnormal pregnancies, and various developmentalmarkers at an earlier stage than with TAS.
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