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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 34  |  Issue : 2  |  Page : 107-111

Transvaginal ultrasound during pregnancy: Perception and acceptability of antenatal clinic attendees at the University College Hospital, Ibadan


1 Department of Radiology, University College Hospital and the College of Medicine, University of Ibadan, Ibadan, Nigeria
2 Department of Obstetrics and Gynaecology, University College Hospital and the College of Medicine, University of Ibadan, Ibadan, Nigeria

Date of Web Publication21-Aug-2017

Correspondence Address:
T. A. O. Oluwasola
Department of Obstetrics and Gynaecology, University College Hospital and the College of Medicine, University of Ibadan, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_26_17

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  Abstract 

Introduction: There has been a tremendous increase in the use of transvaginal ultrasound (TVS) in pregnancy. With the use of high-resolution transducers, the transvaginal probe has proved to be particularly useful for finding the location and dating of early pregnancies when compared with transabdominal sonography (TAS). It has also been shown to be a reliable method for confirming complete miscarriage. This study aims at determining the perception and acceptability of TVS in pregnancy.
Materials and Methods: This is a descriptive cross-sectional study of 424 consenting pregnant women attending the antenatal clinic at the University College Hospital, Ibadan. Using a self-administered questionnaire, we obtained information on their socio-demographic characteristics, awareness of ultrasound and TVS and opinion about TVS including acceptability and perceived complications.
Results: The mean age of the respondents was 31.6 ± 4.7 years. Majority (410; 96.7%) had heard about ultrasound scanning, and 395 (93.2%) had undergone at least one type. Approximately two-fifth (177; 41.7%) had heard about TVS, mostly from antenatal clinic, with two-third having a good knowledge. Only 90 (21.2%) had personal experiences, and 144 (34%) believed it is harmful; however, about three-fifths (256; 60.4%) were willing to do TVS if indicated. Perceived complications of TVS included abortion, infection and bleeding. Awareness and perception were strongly associated with acceptability of TVS but not with education or previous experience.
Conclusion: This study shows that the perception and acceptability of TVS by pregnant women is dependent on their level of awareness. There is an urgent need for proper information dissemination on the usefulness, safety and advantages of TVS in pregnancy.

Keywords: Acceptability; antenatal clinic; perception; pregnancy; transvaginal ultrasound


How to cite this article:
Akinmoladun J A, Oluwasola T. Transvaginal ultrasound during pregnancy: Perception and acceptability of antenatal clinic attendees at the University College Hospital, Ibadan. Trop J Obstet Gynaecol 2017;34:107-11

How to cite this URL:
Akinmoladun J A, Oluwasola T. Transvaginal ultrasound during pregnancy: Perception and acceptability of antenatal clinic attendees at the University College Hospital, Ibadan. Trop J Obstet Gynaecol [serial online] 2017 [cited 2017 Sep 23];34:107-11. Available from: http://www.tjogonline.com/text.asp?2017/34/2/107/213443


  Introduction Top


Ultrasonography is an important radiological examination tool that has positively impacted the quality of medical practice in recent years. In the last two decades, there has been increasing use of transvaginal ultrasound (TVS) in a wide range of obstetric conditions as it has been offered to women with apparently normal pregnancies, either to screen for foetal abnormality or to assess the risk of pre-term delivery.[1] TVS was introduced to improve some of the drawbacks of trans-abdominal ultrasound (TAS) and to improve gynaecological outcomes, especially in terms of detailed evaluation and diagnosis of adnexal masses.[2],[3],[4],[5],[6],[7]

Peculiar advantages of TVS over TAS include production of clear images of the ovaries in follicular assessment, monitoring and retrieval of follicles in infertility management; detailed evaluation of first trimester pregnancies and its complications; earlier detailed anomaly scan at gestational age of 12–13 weeks compared to 16–18 weeks for TAS; cervical length assessment for risk of pre-term deliveries; assessment of placenta location and post-menopausal screening for ovarian cancer risks.[8],[9],[10] The transvaginal or endovaginal transducer enables imaging of the cervix, uterus, ovaries and adnexal regions with increased detail and resolution compared to trans-abdominal pelvic sonography as TVS gives better and detailed information on pelvic organs including the endometrium.[8],[9],[10],[11]

The acceptability and willingness to undergo TVS by pregnant women have generated mixed reactions in different settings.[3],[7],[12],[13] The awareness of TVS as a useful tool in the management of pregnant women and the willingness to have it done in pregnancy has been found to be very low in our environment,[12] even though Atalabi et al. reported an above average rate among some selected participants.[7] However, in an Indian study, majority of the women perceived TVS favourably irrespective of their previous knowledge or experience.[14]

Patient's perception of TVS hinges on their prior knowledge of what TVS is,[15] as well as on their personal opinion of what is acceptable.[1] Factors that predict willingness to accept TVS include parity, previous painful vaginal examination and sexual violence, embarrassment from undue exposure and loss of control.[1],[13],[15] As much as TVS is desirable, its introduction and acceptability requires censoring of clients' opinion to appreciate their feelings towards it. The overall aim of this study is to determine the perception and acceptability of TVS among pregnant women attending the antenatal clinic in Ibadan by assessing their awareness, determining their level of acceptability and associated factors.


  Materials and Methods Top


This was a cross-sectional, questionnaire-based survey of consenting pregnant women attending the antenatal clinic of the University College Hospital (UCH), Ibadan. These pregnant women attended the clinic from various parts of Ibadan and neighbouring states. We adopted a total sampling technique excluding only unbooked and non-consenting women. Using a self-administered questionnaire, we obtained information on the respondents' sociodemographic characteristics such as age, marital status, education level, religion and ethnicity; information about previous births and previous ultrasound scans as well as information on their level of awareness, perception and acceptability of TVS. All respondents provided consent verbally and the confidentiality of their responses was ensured as no personal identifiers were used. Approval was obtained from the Oyo State Ethics Committee before commencement of the study.

Using a prevalence of 56.6% for awareness (Atalabi et al.), a minimum sample size was 378 which, with attrition set at 15%, was increased to 435, out of which 424 were analyzable. The data obtained from the respondents were cleaned, coded and entered into the computer. Analysis was done using the Statistical package for Social Sciences version 23.0 (SPSS, IBM Inc). Descriptive statistics and appropriate cross tabulation were done to determine the study objectives.


  Results Top


We interviewed a total of 424 consenting pregnant women with a mean age of 31.6 ± 4.7 years. Majority (410; 96.7%) had heard about ultrasound, 395 (93.2%) had undergone at least one type of ultrasound, 177 (41.7%) had heard about TVS with two-thirds having good knowledge and 90 (21.2%) had personal experiences [Table 1]. Only three-fifth (256; 60.4%) were willing to undergo TVS if indicated. Perceived complications of TVS included abortion, infection, bleeding and pain [Table 2]. The main sources of information included antenatal clinic health talks, doctors, personal findings and media [Table 3].
Table 1: Sociodemographic characteristics of respondents

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Table 2: Awareness and perception about transvaginal ultrasound

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Table 3: Sources of information about transvaginal ultrasound*

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[Table 4] and [Table 5] depicts the factors associated with acceptability of TVS as well as other relationships. Awareness of TVS is significantly associated with education (χ2 = 9.514; P = 0.049) and the belief that it could be harmful (χ2 = 27.453; P < 0.001), whereas those who had heard were more than twice willing to accept (χ2 = 15.773, P < 0.001; OR = 2.27; 95% CI = 1.51–3.42). In addition, other significant associations found among those who had undergone TVS included education (χ2 = 49.373; P < 0.001); belief that it is harmful (χ2 = 57.929; P < 0.001) and willingness to have a repeat (χ2 = 7.75; P < 0.005; OR = 2.04; 95% CI = 1.23–3.40).
Table 4: Associations between selected variables

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Table 5: Factors associated with awareness and acceptability of transvaginal ultrasound

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There is no difference between those who had ever heard about ultrasonography and willingness to accept TVS (χ2 = 0.032; P > 0.005; OR = 1.10; 95% CI = 0.38–3.33). Those who had only ever heard and those who had ever undergone any form of ultrasonography had divergent views about its safety (χ2 = 6.225, P = 0.044 and χ2 = 2.659; P > 0.05, respectively). Religion has no effect on the acceptability of TVS (χ2 = 1.603; P = 0.206, OR = 1.34; 95% CI = 0.85–2.10) [Table 5]. Associations and findings on logistic regression are presented in [Table 6].
Table 6: Logistic regression of factors associated with acceptance of transvaginal ultrasound

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  Discussion Top


Our study aimed to determine the perception and acceptability of TVS in pregnancy by women attending the antenatal clinic at UCH, Ibadan. We found an above-average level of acceptability (60.4%) among our respondents, which is within the range of 43–96% reported in the literature; only two-fifth of our study population were aware of TVS. When compared with previous studies conducted in this environment, the level of acceptance was higher than 28.8% reported by Komolafe et al.,[12] however, lower than 84% reported by Atalabi et al.[7] The higher figure in the study by Atalabi et al., which was conducted in the general population including women outside the reproductive age group, was attributed to the general receptive attitude of Africans to medical services even when they are associated with some discomfort – a theory supported by Clement et al.[1] Lower level of acceptability among patients interviewed by Komolafe et al. may be attributed to their lack of awareness because only 16.4% of the women knew about the procedure.

The major concern in approximately one-third of our respondents was regarding the harm to the baby rather than the procedure itself. They believed it could cause abortion, abnormal babies and bleeding during pregnancy. This finding agreed with that of Dutta et al. where many of the respondents thought TVS may be adversely related to pregnancy,[16] unlike the findings of Komolafe et al. who reported pain as the major worry of their study participants.[12]

Several factors have been reported to affect the acceptability of TVS among pregnant women. In corroboration with Shetty et al., our study found out that, although a previous experience of ultrasonography and prior knowledge of TVS are important, awareness and perception played a significant role in the acceptability of the procedure than previous experience.[14] However, Onderi et al. reported that patients' perception of TVS was a function of their prior knowledge of the procedure.[15] It is noted that, because perception is dependent on organization, identification and interpretation of stimuli and an unfamiliar stimulus will generate negative perception especially when there is interference with privacy, endocavitary examinations are expected to be dependent on patient's prior knowledge of the procedure for it to be acceptable.[1] Patients' knowledge regarding TVS needs to be maintained in an organized and meaningful manner with a stable, comprehensive view of the entire procedure in ways that are acceptable both culturally and environmentally.[1] These were corroborated in this study where there is a high level of acceptance with more than three-fifths of the study participants accepting to do TVS if indicated in pregnancy and those with a prior knowledge about TVS being more than twice more likely to accept than those who never heard about it. In the cross-sectional study by Komolafe et al.,[12] awareness and acceptance were proportionally low unlike the findings of Atalabi et al. where the level of acceptability was quite high because of series of lectures and visual aids provided regarding the procedure before the interview,[7] thus implying that acceptability is influenced more by awareness rather than previous experience, a finding also corroborated in this study.

Similarly, in tandem with previous reports, it was noted that sociodemographic characteristics have no significant effect on the participants' acceptability of TVS,[4],[7] even though Komolafe et al. and Clement et al. reported a linear relationship between willingness for TVS and some characteristics such as age and parity,[1],[12] which was attributed to the contribution of increasing age and maturity to reduction in anxiety about sexual issues but more interest on pregnancy outcome. In contrast to our findings, Komolafe et al.,[12] reported that participants with secondary education tend to accept TVS more than those with tertiary education, and this was believed to result from the perception that participants with tertiary education might be more cautious in accepting new, untested measures.

Expertise in TVS, rather than gender, is important when offering TVS to any pregnant woman. This is because TVS is a relatively recent advancement in ultrasonography and in inexperienced hands it can cause more harm than good to the mother and/or the foetus. Approximately half of our respondents did not have any gender preference if they needed to undergo a TVS. TVS has become a routine procedure in the developed world for pregnancy assessment and complications in the first trimester,[9],[10] also in the evaluation of cervical length in middle and late pregnancy for risk of pre-term delivery, even though it is a new development in developing countries like Nigeria.[17] From our study, approximately one-third of those who had heard about TVS received information from antenatal clinic health talk whereas only one-fifth heard from their doctors. It is, therefore, important to identify potential means of disseminating information about the usefulness, safety and advantages of TVS in pregnancy and integrate this into our regular practice.


  Conclusion Top


Findings from this study showed that awareness of pregnant women about TVS strongly determine their perception and level of acceptability. Therefore, there is a need to disseminate information on the usefulness, safety and advantages of TVS in pregnancy among health practitioners, patients, general public and ministry of health officers to increase the level of acceptability of the procedure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Clement S, Candy B, Heath V, To M, Nicolaides KH. Transvaginal ultrasound in pregnancy: Its acceptability to women and maternal psychological morbidity. Ultrasound Obstet Gynecol 2003;22:508-14.  Back to cited text no. 1
    
2.
Dashe JS, McIntire DD, Twickler DM. Maternal obesity limits the ultrasound evaluation of fetal anatomy. J Ultrasound Med 2009;28:1025-30.  Back to cited text no. 2
    
3.
Basama FMS, Crosfill F, Price A. Women's perception of transvaginal sonography in the first trimester; in an early pregnancy assessment unit. Arch Gynecol Obstet 2004;269:117-20.  Back to cited text no. 3
    
4.
Chang MY, Chang SY, Soong YK. Transvaginal ultrasound-directed oocyte retrieval for in vitro fertilization. Taiwan Yi Xue Hui Za Zhi 1989;88:689-93.  Back to cited text no. 4
    
5.
Cicero S, Skentou C, Souka A, To MS, Nicolaides KH. Cervical length at 22-24 weeks of gestation: Comparison of transvaginal and transperineal-translabial ultrasonography. Ultrasound Obstet Gynecol 2001;17:335-40.  Back to cited text no. 5
    
6.
Vercellini P, Cortesi I, Oldani S, Moschetta M, De Giorgi O, Crosignani PG. The role of transvaginal ultrasonography and outpatient diagnostic hysteroscopy in the evaluation of patients with menorrhagia. Hum Reprod 1997;12:1768-71.  Back to cited text no. 6
    
7.
Atalabi OM, Morhason-Bello IO, Adekanmi AJ, Marinho AO, Adedokun BO, Kalejaiye AO, et al. Transvaginal ultrasonography: A survey of the acceptability and its predictors among a native African women population. Int J Womens Health 2012;4:1-6.  Back to cited text no. 7
    
8.
Bennett CC, Richards DS. Patient acceptance of endovaginal ultrasound. Ultrasound Obstet Gynecol 2000;15:52-5.  Back to cited text no. 8
    
9.
Braithwaite JM, Economides DL. Acceptability by patients of transvaginal sonography in the elective assessment of first-trimester pregnancy. Ultrasound Obstet Gynecol 1997;9:91-3.  Back to cited text no. 9
    
10.
Kaur A, Kaur A. Transvaginal ultrasonography in first trimester of pregnancy and its comparison with transabdominal ultrasonography. J Pharm Bioallied Sci 2011;3:329-38.  Back to cited text no. 10
    
11.
Rosati P, Guariglia L. Acceptability of early transvaginal or abdominal sonography in the first half of pregnancy. Arch Gynecol Obstet 2000;264:80-3.  Back to cited text no. 11
    
12.
Komolafe JO, Akindele RA, Akinleye CA, Fashanu AO, Adeleke NA, Isawumi AI, et al. Awareness and acceptance of transvaginal ultrasound scanning among ever pregnant women in Nigeria. Womens Health Gynecol 2016;2:12-5.  Back to cited text no. 12
    
13.
Deed K, Childs J, Thoirs K. What are the perceptions of women towards transvaginal sonographic examinations? Sonography 2014;1:33-8.  Back to cited text no. 13
    
14.
Shetty AS, Shetty H, Prabhu R, Shetty P, Hegde D, Kotian MS, et al. Study of awareness towards a more accepted invasive procedure, Transvaginal ultrasound during the first trimester of pregnancy in a rural setup. Asian J Pharm Health Sci 2015;5:1179-81.  Back to cited text no. 14
    
15.
Onderi AO, Joash A, Mugga A. Evaluation of the Patients' Perception Regarding Endocavitary Ultrasound Procedure at the Nyeri Level 5 Hospital, Kenya. Int J Innovative Res Dev 2015;4:13-22.  Back to cited text no. 15
    
16.
Dutta RL, Economides DL. Patient acceptance of transvaginal sonography in the early pregnancy unit setting. Ultrasound Obstet Gynecol2003;22:503-7.  Back to cited text no. 16
    
17.
Cubal A, Carvalho J, Ferreira MJ, Rodrigues G, Carmo OD. Value of Bishop Score andultrasound cervical length measurement in the prediction of caesarean delivery. J Obstet Gynaecol Res 2013;39:1391-6.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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