Document Detail


Pelvic examination is unnecessary in pregnant patients with a normal bedside ultrasound.
MedLine Citation:
PMID:  20159393     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study examines the necessity of a formal pelvic examination in patients with early pregnancy-related complaints and an intrauterine pregnancy on bedside ultrasound (US). METHODS: Data were prospectively collected on emergency department (ED) patients presenting with early pregnancy complaints and bedside US evidence of intrauterine pregnancy. All patients received a formal pelvic examination with cervical testing for sexually transmitted pathogens. Disposition decisions based on pelvic examination findings were compared with disposition decisions based on ultrasound findings alone. RESULTS: Over a 13-month period, 50 patients entered the study. Mean estimated gestational age was 8.6 (+ or - 0.4) weeks. Abnormal speculum examination findings included vaginal blood (19 [38%]) and cervical discharge (3 [6%]). Abnormal bimanual findings included adnexal tenderness (6 [12%]) and uterine tenderness (4 [8%]). One patient (2.5%) had a positive antigen test for Chlamydia trachomatis. Emergency department diagnoses were threatened abortion (30 [60%]), intrauterine pregnancy (11 [22]), abdominal pain (8 [16%]), and ovarian cyst (1 [2%]). Three patients (6%) had incidental urinary tract infections. All patients were discharged from the ED. No management changes were made based on the pelvic examination. CONCLUSION: In patients with a US-documented viable pregnancy, the pelvic examination did not contribute to the patient's immediate obstetric treatment. Occult cervical pathogens may be present in these patients.
Authors:
Amanda Seymour; Heather Abebe; Dan Pavlik; Alfred Sacchetti
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American journal of emergency medicine     Volume:  28     ISSN:  1532-8171     ISO Abbreviation:  Am J Emerg Med     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-17     Completed Date:  2010-03-19     Revised Date:  2010-05-14    
Medline Journal Info:
Nlm Unique ID:  8309942     Medline TA:  Am J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  213-6     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Affiliation:
Department of Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, NJ 08103, USA.
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MeSH Terms
Descriptor/Qualifier:
Female
Humans
Pelvis
Physical Examination*
Point-of-Care Systems
Pregnancy
Pregnancy Complications / diagnosis*,  ultrasonography
Pregnancy Trimester, First*
Prospective Studies
Ultrasonography, Prenatal*
United States
Comments/Corrections
Comment In:
Am J Emerg Med. 2010 May;28(4):532; author reply 532-3   [PMID:  20466250 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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