Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF DISSERTATION
TOPIC
TRANSVAGINAL SONOGRAPHY IN FIRST TRIMESTER OF
PREGNANCY
DR. ADITHI S HEGDE
POSTGRADUATE
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
K.S.HEGDE MEDICAL ACADEMY
DERALAKATTE, MANGALORE - 575018.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
Name of the candidate
And Address
Dr. ADITHI.SATHYANANDA HEGDE
POSTGRADUATE
DEPARTMENT OF OBG
K.S.HEGDE MEDICAL ACADEMY
DERALAKATTE,MANGALORE
KARNATAKA- 575018
2.
Name of institution
K.S.HEGDE MEDICAL ACADEMY
DERALAKATTE,MANGALORE
KARNATAKA-575018
3.
Course of study and subject
MASTER OF SURGERY in
OBSTETRICS AND GYNAECOLOGY
4.
Date of admission to course
31ST MAY 2007
5.
Title of topic
“TRANSVAGINAL SONOGRAPHY IN
THE FIRST TRIMESTER OF
PREGNANCY”
6
BRIEF REUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
First trimester pregnancy is a dynamic period , during which changes occur in
human development at a more rapid rate than any other time during human life1.
First trimester scanning is useful to identify normal pregnancies and abnormalities in
early development of a pregnancy including miscarriage and ectopic pregnancies and
provides the most accurate dating of a pregnancy2 .
Transvaginal ultrasound has revolutionised the diagnosis of early pregnancy as it can
detect a pregnancy at an earlier stage, whether it is normal and therefore reassuring
or abnormal and requires intervention3.
Transvaginal ultrasound has proven to be more accurate than transabdominal scan in
the diagnosis of early pregnancy and its complications.It allows earlier and detailed
visualisation of the gestational sac followed by the yolk sac and embryonic fetal pole
and any abnormalities one week earlier4,5 .
Yolk sac measurement in early gestation is a useful marker for pregnancy outcome2.
6.2 REVIEW OF LITERATURE
According to the study done by Jain KA , Hamper UM , Sanders RC5, 90 women
with symptoms(about 4-5 weeks) were studied. Transvaginal detected 100% of
pregnancies while transabdominal identified only 20%. Yolk sac was identified from
34 days of gestation by transvaginal sonography
and was identified from 42 days
of gestation by transabdominal sonography.
117 first trimester singleton pregnancies were studied by Stampone C, Nicotra M,
Muttinelli C, Cosmi EV 2 to evaluate yolk sac size and abnormalities using
transvaginal ultrasound. A yolk sac of abnormal size was statistically significant ( p
< 0.001 ) in spontaneous abortion when compared with normal pregnancy outcomes
with a sensitivity of 68.7% , a specificity of 99% , positive predictive value of 91.6%
and negative predictive value of 95.2%.
According to the study done by Hernadi L, Farkas M6 on 180 patients in first
trimester in both normal and pathological pregnancies, the sensitivity of transvaginal
sonography in ectopic pregnancies , especially unruptured ectopic pregnancy is very
high.
Among 425 women in first trimester pregnancies studied by Basamar FM, Crosfill F,
Price A,7 transvaginal ultrasound was considered not embarrassing(88.9%),
acceptable(98%), not painful(98.6%) and not stressful(90.6%).
According to the study done by Sydow P, Lisse K, Wilken T ,Pfuller B8 on 401
transvaginal sonographic examinations in first trimester , it is possible to study
details of embryonic development in first trimester 1-2 weeks earlier than with
abdominal ultrasound.
Mariette H Schouwink et al4 studied 372 first trimester pregnancies who underwent
transvaginal ultrasound. Among them 92( 25%) were non-viable. The combination
of absence of both yolk sac and cardiac activity gave a specificity of 99% and
sensitivity of 40%.
6.3. AIMS AND OBJECTIVES:
1. Comparison of Transabdominal and Transvaginal sonography in the first
trimester of pregnancy- normal and pathological
2. To study the significance of the yolk sac- presence, size and shape as a
predictor of pregnancy outcome for the first trimester.
3. To study the women’s perception of transvaginal sonography in first
trimester of pregnancy.
A study was done by Mitra AG et al9 in 141 patients between 6weeks and 11weeks
of gestation who underwent both transvaginal and transabdominal Doppler
evaluation for detection of fetal heart rate. Transvaginally it was detected in 60.5%
and in 87.5% and Transabdominally it was 22.9% and 56% at 8 and 9 weeks
respectively.
Mayank Goyal et al10 compared the Transabdominal and Transvaginal ultrasounds
of 60 patients. According to their study Transvaginal ultrasound has a temporal
advantage of one week over Transabdominal scan in both normal and abnormal
pregnancies.
6.3 AIMS AND OBJECTIVES
1.Comparison of Transabdominal and Transvaginal sonography in the first
trimester of pregnancy- normal and pathological
2.To study the significance of the yolk sac as a predictor of pregnancy outcome in
the first trimester .
3.To study the women’s perception of transvaginal sonography in first trimester of
pregnancy.
7.
MATERIALS AND METHODS
7.1 SOURCE OF DATA
100 patients attending the OBG out patient department, inpatient wards of
K.S.Hegde Charitable Hospital between November 2007 to June 2009 diagnosed to be
in the first trimester of pregnancy, with their consent will be included.
Inclusion criteria:
All patients in the gestational age of 5- 12 weeks come either for confirmation of
pregnancy , confirmation of gestational age or any other pregnancy related complaints
who have given their consent will be included.
Exclusion criteria
1.All patients in the gestational age of 5- 12 weeks who have not given
their consent will be excluded.
2. If the patient has an active pelvic infection.
7.2 METHOD OF COLLECTION OF DATA
Its a prospective study of a total of 100 patients with first trimester pregnancies.
First a detailed History with thorough physical examination is done. Urine pregnancy
test is done if not done before following which routine blood investigations and urine
tests are done.
Then ultrasound study is done on the patient.
The Machine used for the study is-LOGIC 400 PROGE series
The transducers used were1.For transabdominal scan: 3.5 MHz transducer
2.For transvaginal scan : 7 MHz transducer
For each patient, first a trans abdominal scan is done on full bladder after
which
the patient empties her bladder and a transvaginal ultrasound was done.
At each sonographic evaluation the following parameters are noted1. Gestational sac- location and measurement
2. Yolk sac3. Fetal pole
4. Crown rump length
5. Cardiac activity
6. Limb buds
7. Embryo body movements
A scan is considered normal if it showed all the normal sonological features
that particular gestational age and was considered abnormal if it showed any
deviation from the findings considered normal for that particular gestation . The
yolk sac was studied in detail.
Then the patient’s perception of transvaginal ultrasound was also assessed by asking
her certain questions.
The patient will be followed up till end of first trimester and the pregnancy
outcome will be noted.
7.3 Does the study require any investigations or interventions to be conducted
on patients or other humans or animals? If so, please describe briefly
Yes , Investigations – Urine pregnancy test if not done before, routine blood
investigations, urine test and Ultrasound- Transabdominal and Transvaginal.
7.4 Has ethical clearance been obtained from your institution in case of
7.3?
Yes
8.
LIST OF REFERENCES
1.Levi CS, Lyons EA, Lindsay DJ, Ultrasound in first trimester of pregnancy, fetal
ultrasound . Radiologic Clinics of North America 1990; 28(1)
2.Stampone C, Nicotra M, Multinelli C, Cosmi EV, Transvaginal sonography of the
yolk sac in normal and abnormal pregnancy. J Clinical Ultrasound 1996 Jan ; 24(1) :
3-9
3.Sawyer E, Jurkovic D, Ultrasonography in diagnosis and management of abnormal
early pregnancy. Clinical Obstetrics Gynaecology 2007 March; 50(1) :31-54
4.Mariette H Schouwink, Bianca F Fong, Ben WJ Mol and Fulco van der Veen,
Ultrasonographic criteria for non-viability of first trimester intrauterine pregnancy.
Fertil Steril 2000 July ; IV(3) : 203-213
5..Jain KA, Hampu UM, Sanders RC, Comparison of transvaginal sonography and
transabdominal sonography in detection of early pregnancy and its complications.
AJR 1988; 151: 1139
6.Hernadi L, Torocsik M, Farkas M, Significance of transvaginal ultrasonic
examination in the first pregnancy trimester. Orv Hetil 1990 Dec ;131(49) : 2687-91
7.Basama FM, Crosfill F, Price A, Women’s perception of transvaginal ultrasound in
the first trimester; in an early pregnancy assessment unit.Arch Gynecol Obstet 2004
Jan; 269(2): 117-20.
8.Sydow P, Lisse K, Wilken T, Pfuller B, Vaginal sonography in diagnosis of early
pregnancy. Zentralbe Gynekol 1989 ; 111(7) : 453-60
9.Mitra AG, Laurent SL, Moore JE, Blanchard GF Jr, Chescheir NC, Transvaginal
versus transabdominal Doppler auscultation of fetal heart activity: A comparative
study. July; 175(1) : 41-4
10.Mayank Goyal, Sushma Vashisht, Manorama Berry, Supriya Mayank, Vijay
Lakshmi Bhargava, Comparitive evaluation of transabdominal and transvaginal
sonography in first trimester of pregnancy: Ind J Radiol Imag 1994;4 :157-162.
9.
Signature of candidate
10.
Remarks of the guide
11.
Name and designation of
(in block letters)
11.1 Guide
Dr.HARISH SHETTY
MBBS MD DGO
ASSOCIATE PROFESSOR
DEPARTMENT OF OBG
KSHEMA, MANGALORE
11.2 Signature
11.3 Co-guide(if any)
Dr. RABINDRA PRABHU
MDRD
PROFESSOR AND HOD
DEPARTMENT OF RADIOLOGY
KSHEMA, MANGALORE
11.4 Signature
11.5 Head of the department
Dr. D.K.SHETTY
DGO, MRCOG ,FRCOG
PROFESSOR AND HOD
DEPARTMENT OF OBG
KSHEMA, MANGALORE
11.6 Signature
12.
12.1 Remarks of the chairman and
Principal
12.2 Signature
PATIENT INFORMED CONSENT FORM
Study title : “ TRANSVAGINAL SONOGRAPHY IN THE
TRIMESTER OF PREGNANCY”
FIRST
INFORMATION
First trimester scanning is a safe investigation which provides reassuarance , charts the normal
development and identifies women with abnormal high risk pregnancy.
My aim is to compare the transabdominal and transvaginal sonography in the first trimester of
pregnancy – normal and pathological and to study the prognostic value of the ultrasound of yolk sac in
first trimester of pregnancy and to study the women’s perception of transvaginal ultrasound.
In the study all women with first trimester pregnancy will be asked a detailed history , followed by a
physical examination and will be subjected to investigations- routine blood investigations and urine test
and ultrasound- transabdominal and transvaginal and will be asked certain questions with regards to
the perception of women on transvaginal ultrasound.
CONSENT
I ------------------------------- declare that I have been briefed and hereby consent to be included as a
subject in the following dissertation “ Transvaginal Sonography In First Trimester Of Pregnancy” .
I have been informed to my satisfaction by the attending Dr. Adithi . Sathyananda . Hegde, the purpose
of work done and the required investigations .
This has been explained to me in the language I understand and I fully consent for the same.
Signature of the doctor
Name of the doctor:
Date:
Signature of the patient
PROFORMA
NAME:
OP/IP NO.:
AGE:
ADDRESS:
SEX:
DATE:
PRESENTING COMPLAINTS:
LMP:
EDD:
OBSTETRIC – HISTORY:
MARRIED LIFE:
MENSTRUAL- HISTORY:
CYCLES:
PAST- HISTORY:
FAMILY- HISTORY:
PERSONAL- HISTORY
OBSTETRIC – FORMULA:
ON EXAMINATION:
EDEMA:
ICTERUS:
VITAL SIGNS:
Temp:
PR:
HT:
RR:
BP:
THYROID:
BREAST:
CVS:
RS:
OBSTETRIC EXAMINATION:
P/A:
P/S:
INVESTIGATIONS:
Hb:
BL. GROUP:
PCV:
RBS:
OTHERS:
1.GESTATIONAL- SAC
-SITE
:
-SIZE
:
-SHAPE
:
2.YOLK SAC
-PRESENT/ABSENT:
-SHAPE
:
-SIZE
:
- If abnormal – details:
:
4.CROWN RUMP LENGTH:
5.CARDIAC PULSATION:
6.FETAL MOVEMENTS :
7.LIMB BUDS
IMPRESSION:
:
P/V:
URINE-ROUTINE:
URINE PREGNANCY TEST:
ULTRASOUND EXAMINATION:
PARAMETERS
TRANSABDOMINAL
3.FETAL POLE
WT:
:
TRANSVAGINAL
PALLOR:
PATIENT’S PERCEPTION OF TRANSVAGINAL SONOGRAPHY:
Do you have a prior knowledge of trasvaginal ultrasound?
Did you find it embarrassing?
Did you find it painful?
If it has to be repeated will you consent for it again?
ADVISE:
FOLLOW UP: