Publication:

Comparative study of transperineal and transvaginal sonography for localization of placenta in antepartum haermorrhage

Background Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and  provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography.  Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography.

Methods Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken.

Results TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS  negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%.

Conclusions So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta.