Pelvic examination is unnecessary in pregnant patients with a normal bedside ultrasound

Abstract

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.