Évaluation des Connaissances et Attitudes Pratiques en Échographie Systématique du Premier Trimestre de Grossesse au Cameroun.

Objectif  : Evaluer les connaissances et les attitudes pratiques des  echographistes  pour ce qui est du terme de  realisation d’une echographie systematique du premier trimestre de grossesse (EST1), de son etude morphologique  et biometrique, et des images obligatoires devant accompagner son compte-rendu. Materiels et methodes  : Un questionnaire pre-teste comportant plusieurs questions en rapport les connaissances et les attitudes pratiques en matiere d’EST1, etait auto-administre a  87 praticiens d’echographie obstetricale dans les trois plus grandes villes du Cameroun entre septembre et octobre 2012. Apres explications et obtention du consentement du praticien, le questionnaire lui etait remis a son lieu d'exercice, celui-ci le remplissait en presence de l’enqueteur et le lui remettait immediatement. Resultats  : Le taux de reponse etaient de 89,65% (78/87). Les participants etaient 29 residents  en imagerie medicale, 18 radiologues, 13 gynecologues, 8 medecins generalistes et 10  autres. Le terme pour la realisation d’une EST1 etait connu de 52,56% de praticiens avec le meilleur taux (76,9%) des gynecologues (P=0.03). Seuls sept (9%) praticiens avaient correctement cite les images obligatoires a joindre aux comptes-rendus. La LCC etait reconnu comme parametre le plus fiable pour la datation pour 74,36% mais les criteres pour sa bonne mesure n’etaient reconnus que de 31 participants (39,7%). L’etude morphologique etait systematique pour 47,4%. Trente-six praticiens (46,2%) n’avaient pu citer aucune malformation a rechercher systematiquement lors d’une EST1. Dix-huit participants avaient valablement cite tous les criteres pour une bonne mesure de la clarte nucale. La moyenne quantitative de bonnes reponses aux questions etait de 12,5±5,7/25 avec une difference statistiquement significative entre les differents groupes (p<0.005). Conclusion : Les connaissances sur le contenu et la pratique de l’EST1 ne sont pas optimales. Les radiologues et les gynecologues avaient une meilleure connaissance que les autres praticiens. Il existe une grande variabilite des connaissances entre les differents praticiens, et entre les bases theoriques et les attitudes pratiques. Abstract Background : Routine first trimester ultrasonography (RUT1) is framed in many countries by regulatory standards defining the term and contents of the examination with respect to the gestational term for RUT1, fetal morphology and biometric examination, and the compulsory images to accompany the ultrasound report. Our objective was to assess the knowledge and practical attitudes of Sonographers during RUT1 in Cameroon. Materials and Methods : A pre-tested questionnaire with several questions related to knowledge and practical attitudes during RUT1 was self-administered to 87 Sonographers in the three biggest cities in Cameroon between September and October 2012. The questionnaire was given to all consenting sonographers at their place of work. After explanations, the questionnaire was filled in the presence of the investigator and collected on completion. Results : The response rate was 89.65% (78/87). Participants were made up of 29 residents in medical imaging, 18 radiologists, 13 gynecologists, 8 GPs and 10 others. The pregnancy term for carrying out RUT1 was known by 52.56% practitioners with the highest rate of good answers (76.9%) from gynecologists (P=0.03). Only seven (9%) sonographers had properly cited the compulsory images that systematically accompany the RUT1 report. The crown rump length was cited as the most reliable parameter for pregnancy dating by 74.36% participants, but the criteria for its reliable measurement were recognized only by 31 participants (39.7%). Fetal morphology study was systematically done by 47.4% of participants. Thirty-six sonographers (46.2%) did not know any major fetal malformation to systematically check for during RUT1. Eighteen participants had correctly cited all the criteria for reliable measurement of the nuchal translucency. A quantitative evaluation of the correct answers gave a mean of 12.5 ± 5.7 / 25 with a statistically significant difference between groups (p <0.005). Conclusion : Knowledge on the content and practice of routine ultrasound of the first trimester is not optimal. Radiologists and gynecologists had better knowledge than other sonographers. There is a wide variability of knowledge between practitioners, and between theoretical and practical attitudes. Keywords : Assessment, First trimester, Routine Ultrasonography, Fetal malformations, Nuchal translucency, Crown rump length (CRL), Practical attitudes.