Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 10 , ISSUE 4 ( October-December, 2016 ) > List of Articles

RESEARCH ARTICLE

Accuracy of Ultrasounds in the Diagnosis of Placenta Previa by Nonradiologists in Cameroon

Fouelifack Y Florent, Patrick BA Ohanda, Jeanne H Fouedjio, Jovanny T Fouogue, Loic D Fouelifa, Robinson E Mbu

Keywords : Accuracy,Cameroon,Diagnosis,Nonradiologists,Placenta previa,Ultrasound

Citation Information : Florent FY, Ohanda PB, Fouedjio JH, Fouogue JT, Fouelifa LD, Mbu RE. Accuracy of Ultrasounds in the Diagnosis of Placenta Previa by Nonradiologists in Cameroon. Donald School J Ultrasound Obstet Gynecol 2016; 10 (4):403-408.

DOI: 10.5005/jp-journals-10009-1492

License: CC BY-NC 4.0

Published Online: 01-09-2017

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Objectives

Ultrasound evaluation could ensure early diagnoses prior to the onset of clinical manifestations. The use of ultrasound as a diagnostic tool for varying disease states is gaining ground in Africa; however, its operator dependence constitutes a major setback. Our main goal was to evaluate the accuracy of ultrasound in the diagnosis of placenta previa (PP) in Cameroon, and especially its use by nonradiologists.

Materials and methods

We carried out a cross-sectional prospective study in the maternity unit of the Yaoundé Central Hospital during a period of 13 months (December 1, 2014 to December 31, 2015). Our study population involved women with prior cesarean section irrespective of the indication at least 28 weeks of gestational age. During surgery the diagnosis was confirmed. We included all women with a past history of cesarean section who underwent a 3rd trimester ultrasound scan (USS), especially in the last 4 weeks preceding the cesarean section.

Results

The mean age of our study population was 28.02 years (± 6.13 years), with age extremes at 13 and 44 years respectively. Out of 761 women who underwent cesarean section, 153 had been diagnosed preoperatively with PP. All the USSs were transabdominal. Third trimester scans irrespective of the operator had a sensitivity of 82, and 99% specificity. Among the operators, radiologists and obstetricians had the best sensitivity rates (83 and 81% respectively) as against 71.4% among other operators.

Conclusion

Ultrasound scanning is important in the antenatal period as a diagnostic tool for PP when carried out by radiologists and obstetricians. Routine use of the transvaginal and transperineal routes should be encouraged so as to gain in accuracy during 3rd trimester scanning. However, the nonradiologists need to be trained because of the accuracy lapses involving the USSs which they carry out.

How to cite this article

Florent FY, Ohanda PBA, Fouedjio JH, Fouogue JT, Fouelifa LD, Mbu RE. Accuracy of Ultrasounds in the Diagnosis of Placenta Previa by Nonradiologists in Cameroon. Donald School J Ultrasound Obstet Gynecol 2016;10(4):403-408.


PDF Share
  1. Hémorragie du troisième trimestre de la grossesse: orientation diagnostic. Rev Prat 1991 Mar 21;41(9):835-838.
  2. Traité d'obstétrique, Placenta prævia. Flammarion Médecine 2003;p. 922-926.
  3. Placenta previa: a 22-year analysis. Am J Obstet Gynecol 1999 Jun;180(6 Pt 1): 1432-1437.
  4. Mortalité maternelle: hémorragie du troisième trimestre de la grossesse. Int J Obstet Gynecol 2004;24:372-373.
  5. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol 2015 Sep;126(3):654-668.
  6. Prevalence of placenta previa by world region: a systematic review and meta analysis. Trop Med Int Health 2013 Jun;18(6):712-724.
  7. Placenta previa at University Hospital Yaoundé, Cameroon. Int J Gynecol Obstet 2013 Mar;120(3):286-288.
  8. Ante-partum haemorrhage: an update. Int J Obstet Gynecol 2008 May;28(4):377-381.
  9. The conservative aggressive management of placenta previa. Am J Obstet Gynecol 1980 Jul 15;137(6):687-695.
  10. Données statistiques sur le placenta previa. J Internat Coll Surgeous 1964;42(1):40-46.
  11. Maternal and perinatal morbidity resulting from placenta previa. Obstet Gynecol 1985 Feb;65(2):176-182.
  12. Role of imager in developing world. Lancet 1997 Aug 9;350(9075):426-429.
  13. Management of placenta previa and accreta. J Obstet Gynaecol 2011;31(1):1-6.
  14. Localisation placentaire échographique dans les insertions basses; difficultés: le placenta migrateur Soirée échographique. Gynecol Obstet 1976;(5):3751.
  15. Placenta previa and placenta previa accreta: diagnosis and management. Vol. 12. London (UK): RCOG; 2005. p. 27.
  16. Accuracy and safety of transvaginal sonographic placental localization. Int J Obstet Gynecol 1990 Nov;76(5 Pt 1):759-762.
  17. Comparison of the accuracy of trans-abdominal sonography (TAS) and transperineal sonography (TPS) in the diagnosis of placenta previa. Niger Postgrad Med J 2006 Mar;13(1):21-25.
  18. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior cesarean section. Ultrasound Obstet Gynecol 2006 Aug;28(2):178-182.
  19. Role of transperineal sonography in diagnosis of placenta previa/accreta: a prospective study. Egypt J Radiol Nucl Med 2012 Dec;(43):637-645.
  20. Outcomes of pregnancies with a low-lying placenta diagnosed on second-trimester sonography. J Ultrasound Med 2014 Apr;33(4):691-696.
  21. The relevance of placental location at 20-23 gestational weeks for prediction of placenta previa at delivery: evaluation of 8650 cases. Ultrasound Obstet Gynecol 2001 Jun;17(6):496-501.
  22. Diagnosis of low-lying placenta: can migration in the third trimester predict outcome? Ultrasound Obstet Gynecol 2001 Aug;18(2):100-102.
  23. Placenta previa: the role of ultrasound in assessment during third trimester. J Pack Med Assoc 2004 Feb;54(2):81-83.
  24. Placenta previa, placenta accreta, and vasa previa: review. Obstet Gynecol 2006 Apr;107(4):927-941.
  25. Transvaginal ultrasonography at 18–23 weeks in predicting placenta previa at delivery. Ultrasound Obstet Gynecol 1998 Dec;12(6):422-425.
  26. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003 Mar;13(3):175-190.
  27. Early identification of placenta previa. Br J Obstet Gynaecol 1990 Oct;97(10):959-961.
  28. Diagnosis and management of placenta previa. Int J Gynecol Obstet Canada 2007 Mar;29(3):261-273.
  29. Interventional radiology. Lancet 1997 Aug 2;350(9074):354-358.
  30. The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service. Injury 2007 Jan;38(1):71-75.
  31. Diagnostic instrumentation aboard ISS: just-in-time training for non-physician crewmembers. Aviat Space Environ Med 2005 Jun;76(6) 594-598.
  32. Surgeon-performed sonographic findings in a traumatic trans-anal rectal perforation. World J Emerg Surg 2011 Aug 12;6:26.
  33. Ultrasound in Emergency Care. 2004;104.
  34. Portable ultrasound for difficult central venous access. Br J Anaesth 1999 Jun;82(6):822-826.
  35. Editorial II: Ultrasound imaging by anaesthetists: training and accreditation issues. Br J Anaesth 2006 Apr;96(4):414-417.
  36. The early management of gunshot wounds part II: the abdomen, extremities and special situations. Trauma 2007;9(1):47-71.
  37. Prospective evaluation of non-radiologist performed emergency abdominal ultrasound for haemoperitoneum. Emerg Med J 2004 Sep;21(5):580-581.
  38. Portable ultrasound in pre-hospital emergencies: a feasibility study. Acta Anaesthesiol Scand 2006 Jun;50(6):754-758.
  39. Use of ultrasound by emergency medical services: a review. Int J Emerg Med 2008 Dec;1(4):253-259.
  40. Medical imaging: everyone's a radiologist now. Br Med J 2008 May 10;356(7652):1041-1043.
  41. Emergency ultrasound of the abdominal aorta by UK emergency physicians: a prospective cohort study. Emerg Med J 2007 Aug;24(8):547-549.
  42. Should ultrasound guidance be used for central venous catheterisation in the emergency department? Emerg Med J 2005;22:158-164.
  43. Comparative increases in utilization rates of ultrasound examinations among radiologists, cardiologists, and other physicians from 1993 to 2001. J Am Coll Radiol 2004 Aug;1(8):549-552.
  44. Diagnostic accuracy of nonradiologist performed ultrasound for abdominal aortic aneurysm: systematic review and meta-analysis. Int J Clin Pract 2014 Sep;68(9):1122-1129.
  45. Musculoskeletal sonography by rheumatologists: the challenges. Rheumatology 2002 Mar;41(3):241-242.
  46. A modular, flexible training strategy to achieve competence in diagnostic and interventional musculoskeletal ultrasound in patients with hip osteoarthritis. Rheumatology 2007 Oct;46(10):1583-1586.
  47. Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies. Rheumatology 2010 Dec;49(12):2438-2443.
  48. Do gastroenterologists want to be trained in ultrasound? A national survey of trainees in gastroenterology. Gut 1999 Jan;44(1):123-126.
  49. Early diagnosis, treatment and follow-up of cystic echinococcosis in remote rural areas in Patagonia: impact of ultrasound training of non-specialists. PLoS Negl Trop 2012 Jan;6(1): 1444.
  50. Ultrasound-guided internal jugular venous cannulation: an introduction for non-radiologists to a technique that is here to stay. J La State Med Soc. 2001 Mar;153(3):142-152.
  51. Impact of the introduction of ultrasound services in a limited resource setting: rural Rwanda 2008. BMC Int Health Hum Rights 2009 Mar 27;9:4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.