ULTRASOUND IN THE ETIOLOGICAL ASSESSMENT OF HEMORRHAGES DURING THE 3RD TRIMESTER OF PREGNANCY AT THE FERTILIA MEDICAL CLINIC IN BAMAKO

Background: Haemorrhage in the third trimester of pregnancy is a major public health problem because it can jeopardize the vital prognosis of the mother and the fetus. The objective of our study was to study the sonographic etiologies of hemorrhages in the 3rd trimester of pregnancy. Subjects and Methods: This was a 5-year cross-sectional and prospective study, between JUNE 2017 and MAY 2022, which involved 82 pregnant women who were between 28 and 40 weeks of amenorrhea (SA) and who presented with hemorrhage regardless of its volume. The data collected was obtained on the ultrasound reports and a series of questions asked either of the patient or her companions. Data were entered and analyzed on SPSS version 26.0. Results: In our study, we performed 12,900 obstetrical ultrasounds, of which 82 women had hemorrhage, i.e. a frequency of 0.63%. The average age was 29 years with extremes ranging from 17 to 43 years. 39 patients or 47.5% were between 20 and 30 years old. 42 patients or 51% were multi gestures. 51 patients or 62% were multiparous. The clinical information prompting an ultrasound was abdominal pain + metrorrhagia in 58.5% of cases. 70.7% were between 37 SA and 42 SA. The sonographic etiologies were retroplacental hematoma (HRP) with 56% placenta previa (33%), placenta previa+HRP (2.2%) and uterine rupture (1.8%). Conclusion : Faced with the occurrence of metrorrhagia in the 3rd trimester of pregnancy, it is always necessary to think of the most serious etiologies, which are ultimately not so rare and can jeopardize the vital prognosis of the mother and the child. A targeted questioning and a concise clinical examination make it possible to quickly orient towards an etiology. Ultrasound is an invaluable diagnostic and prognostic aid. The speed of emergency care can sometimes save the child, most often the mother.