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Abstract SUMMARY Sonography IS considered the imaging procidure of choice in evaluating patient with third-trimester bleeding. However, placenta previa can be difficult to diagnose with transabdominal sonography during the third trimester of pregnancy. Sonographic evaluation of 180 patients with third-trimester bleeding was performed by using transperineal and transabdominal sonographic technique. Transabdominal sonograms had been inconclusive for placenta previa in 128 of these patients because the cervix was not visulaized, the remainng 52 had transabdominl scan that show placenta previa. Transperineal sonography successfully visualized the internal surface of the cervix in all 180 cases allowing determination of the presence of absence of placenta previa in all cases. Transperineal sonograms showed the absence of placenta previa in 122 cases. At delivery nene of these patients had evidence of placenta previa. Transperineal sonography showed placenta previa in 58 patients. In 55 of these cases, placenta previa was confermed at delivery. The other 2 patients did not have clinically significant placenta previa at delivery. 84 CONCLUSION Transperineal sonography is a safe accurate and rapid technique to complement transabdominal sonography for evaluation of patients with third-trimester bleeding with patient acceptence and tolerance, without the need of vaginal penetration or manipulation of the cervix which is very important in such cases. Transperineal somography should not replace transabdominal sonography in evaluation of patient with placenta previa. Sonography in these cases nequires visualization of both the inferior edge of the placenta and the cervix. The cervix is almost always seen on trans perineal sonograms, but the lower edge of the placenta is usually the feild of vew. In such cases transabdominal sonograms facilitate visualization of the lower edge of the placenta. Use of transperineal should be strongly considered when a definitive diagnosis regarding placenta previa is not possible by transabdominal sonography becanse the cervix is not visualized. In sbich . cases, trarsperineal sonography will usually show the internal surface of the cervix without overlying placental tissue, allowing confident exclusion of placenta previa. Occasionally, however, transperineal sonography will show a placenta previa that was not seen with transabdominal sonography. This technique is important in obstetric practice and needs further study to ralidate its potential application in other obstetric pnblems as PROM or cervical in comptence. |