THE ROLE OF ULTRASOUND IN DETECTION OF EARLY SIGNS OF THREATENED ABORTION IN FIRST TRIMESTER OF PREGNANCY

Abstract

Background: Threatened abortion is one of the most common complications of early pregnancy and presents with vaginal bleeding, with or without lower abdominal pain, while the cervical os remains closed. Early identification of viable and non-viable pregnancies is essential to reduce maternal morbidity and improve pregnancy outcomes. In rural areas of District Bhakkar, transabdominal ultrasound is often the most accessible and culturally acceptable imaging modality for evaluating first-trimester pregnancies. Objective: To assess the role of transabdominal ultrasound in the diagnosis and evaluation of threatened abortion during the first trimester and to identify sonographic markers associated with pregnancy outcome. Methodology: A cross-sectional descriptive study was conducted at Hassan Doppler Ultrasound, Bhakkar. A sample of 100 pregnant women with gestational age ≤12 weeks presenting with symptoms suggestive of threatened abortion was included through non-probability convenient sampling. Ultrasound examinations were performed using a 3.5–5 MHz convex transabdominal probe. Sonographic parameters including gestational sac, yolk sac, fetal pole, fetal cardiac activity, subchorionic hematoma, and Doppler findings were assessed. Data were analyzed using descriptive statistics, frequencies, percentages, tables, and figures. Results: Most participants were aged 25–30 years (42%) and belonged to rural areas (73%). Vaginal bleeding with lower abdominal pain was the most common presentation (43%). Ultrasound confirmed viable intrauterine pregnancy in 52% of cases, while pregnancy failure was identified in 38%. The most important sonographic predictors of poor outcome included irregular gestational sac (28%), absent fetal cardiac activity (28%), abnormal yolk sac (24%), embryonic bradycardia (20%), and subchorionic hematoma (30%). A definitive diagnosis was achieved during the first scan in 85% of participants. The diagnostic performance of transabdominal ultrasound demonstrated sensitivity of 92%, specificity of 96%, positive predictive value of 94%, negative predictive value of 95%, and overall accuracy of 94%. Conclusion: Transabdominal ultrasound is a reliable, safe, affordable, and culturally acceptable first-line imaging modality for the evaluation of threatened abortion in rural settings. It effectively differentiates viable from non-viable pregnancies, identifies important prognostic markers, guides clinical management, and reduces unnecessary interventions. Routine use of transabdominal ultrasound should be encouraged in women presenting with first-trimester bleeding and pain.

Keywords: Threatened abortion, transabdominal ultrasound, first trimester pregnancy, miscarriage, sonographic markers, rural healthcare, pregnancy viability.