Contribution of echography in the management of haemorragies of the first quarter of pregnancy at the reference health center of the commune VI of Bamako (Mali)

Abstract

Objective: To study the place of emergency ultrasound in the etiological diagnosis of haemorrhagia of the first trimester of pregnancy in the radiology department of the Reference Health Center of Commune VI of Bamako.

Methodology:This was a prospective and descriptive study over 12 months, from January to December 2017 in the radiology service of the reference health center (C.S.REF) in commune VI of the district of Bamako. The study included pregnant women who received a pelvic ultrasound for first trimester metrorrhagia (ultrasound dating less than or equal to 15 weeks of amenorrhea).

Results: 115 cases were collected during the study period. The prevalence of first trimester bleeding has been estimated at 3.09%. The average age of the women was 24 with extreme ages of 16 and 41. No medical and surgical history was found in 35.7% (n = 41) of our patients. Primiparas and paucigests represented 37.4% and 61.7% of the workforce, respectively. Spontaneous bleeding associated with pelvic pain was the main reason for the ultrasound examination with 74.8%. The mean gestational age on ultrasound was 10 weeks (weeks of gestation) with extremes of 5 weeks and 14 weeks. Ectopic pregnancy (EGU) and molar pregnancy represented 6.10% (n = 7) and 2.6% (n = 3). Ovular debris, trophoblastic detachment with hematoma and arrested pregnancies were the main anomalies found with 22.6%, 16.5% and 12.2%. Normal active pregnancy with no ultrasound abnormality was observed in 31.3% of cases. Therapeutically, rest was the treatment provided in 53.3% (n = 69) followed by manual intrauterine aspiration (AMIA) with 46 cases or 40%. Surgery with annexectomy for cases of GEU (6.1%). Forty patients received an isogroup and isorhesus blood transfusion. Probabilistic antibiotic therapy was instituted in 13% of the patients (n = 15) and all of our patients received iron folic acid supplementation.

Conclusion: Ultrasound is an essential examination in the etiological assessment of bleeding in the first trimester of pregnancy.