Making Pelvic Examinations Unnecessary in 1st Trimester
The Article: Pelvic examination is unnecessary in pregnant patients with a normal bedside ultrasound. Seymour A, Abebe H, et al, American Journal of Emergency Medicine, (2010) 28, 213-216.
The Idea: Can pelvic examinations be skipped in a first trimester pregnancy where the patient is reporting abdominal pain and /or vaginal bleeding in which an intra-uterine pregnancy is seen on ultrasound? Is there any difference in disposition between patients that would receive only an ultrasound vs. those that also underwent a pelvic exam?
The Study: 50 patients were enrolled over a 13 month time frame, with an average pregnancy of approximately 8.5 weeks. All patients had both ultrasounds and pelvic exams, and the doctors were asked if the results of the pelvic exam changed their disposition plans after seeing an intra-uterine pregnancy on ultrasound initially.
The Findings: While a small number of patients were found to have diagnoses unrelated to a pregnancy (and STD, ovarian cyst), none of the disposition plans were changed based on the findings of the pelvic exam.
The Takeaway While disposition may not have changed, the value of information gleaned from a pelvic exam – most importantly if the cervical os is opened and if there is a threatened vs. impending abortion – is still important to our patients. The study was only limited to one site, with no repeated studies in other hospitals. It also had a very small patient population given the duration of the study