Does speculum examination have a role in assessing bleeding in early pregnancy?
1Accident and Emergency Department, Chelsea and Westminster Hospital, London, UK. rachelhoey@hotmail.com <rachelhoey@hotmail.com>
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.
Related Concept Videos
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
01:25Assessment of the Abdomen I: Inspection and Auscultation
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
01:30Epistaxis
Etiology
Possible causes of this condition include high blood pressure, trauma, low humidity, upper respiratory tract infections, allergies, foreign bodies, nasal inhalation of corticosteroids or illicit drugs, excessive use of decongestant nasal sprays, facial or nasal surgery, anatomic malformation, tumors, or systemic...