Katherine Isoardi, B. Medicine, Registrar.
Review article: The use of pelvic examination within the emergency department in the assessment of early pregnancy bleeding
Article first published online: 24 NOV 2009
© 2009 The Author. Journal compilation © 2009 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 21, Issue 6, pages 440–448, December 2009
How to Cite
Isoardi, K. (2009), Review article: The use of pelvic examination within the emergency department in the assessment of early pregnancy bleeding. Emergency Medicine Australasia, 21: 440–448. doi: 10.1111/j.1742-6723.2009.01227.x
- Issue published online: 24 NOV 2009
- Article first published online: 24 NOV 2009
- Accepted 30 September 2009
- ectopic pregnancy;
- emergency department;
- physical examination;
- spontaneous abortion
Early pregnancy bleeding is a common presentation in the emergency setting. Traditionally, its assessment relied on clinical findings, including pelvic examination. However in recent years, ultrasonography and quantitative beta human chorionic gonadotropin assays have gained prominence and are now first-line in diagnosing early pregnancy bleeding. Accordingly, the role of pelvic examination in the acute setting has been increasingly questioned. This article reviews the evidence for the role of pelvic examination in the assessment of early pregnancy bleeding in the ED. A Medline search was conducted and 43 articles were included in this review. Applicable research is largely observational and of a low level of evidence. However, available data indicate that the role of pelvic examination in the assessment of early pregnancy bleeding is limited, providing that there is prompt access to transvaginal ultrasound examination. Pelvic examination does not provide further diagnostic information over ultrasonography used in conjunction with beta human chorionic gonadotropin assays. The routine use of pelvic examination is not supported by the literature. However, when ultrasonography and beta human chorionic gonadotropin testing are unavailable or the results inconclusive, pelvic examination should be considered. Assessment in these instances must focus on identifying possible life-threatening conditions, such as ectopic pregnancy, as well as determining the safety of discharge pending definitive assessment. Speculum examination is indicated in those presenting with severe bleeding or hypotension as removal of obstructing endocervical products can be a crucial resuscitative measure.