Objectives: To assess to what extent a speculum examination after a bimanual examination influences the accuracy of diagnosis and subsequent management of women with bleeding in early pregnancy in an accident and emergency (A&E) department.
Method: A prospective study over a five month period included women presenting to A&E with vaginal bleeding at <20/40. Exclusion criteria were haemodynamic instability or known cervical carcinoma. The clinician recorded a diagnosis and management plan on a standard questionnaire after bimanual examination and after subsequent speculum examination.
Results: 236 women were included in the study. Of these, a total of three (1.3%) had a change of management plan and 10 (4.2%) patients had a change of diagnosis after speculum examination.
Conclusion: The results suggest that speculum examination contributes to a minority of management decisions. The need for speculum examination should be assessed on a case by case basis depending on whether the findings on bimanual are conclusive.
- vaginal bleeding
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Conflicts of interest: none declared.