title: Does speculum examination have a role in assessing bleeding in early pregnancy?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Accident and Emergency Department, Chelsea and Westminster Hospital, London, UK. rachelhoey@hotmail.com <rachelhoey@hotmail.com>
authors.forename: R
authors.initials: R
authors.lastname: Hoey
authors.forename: K
authors.initials: K
authors.lastname: Allan
mesh_terms: D000022:Abortion, Spontaneous / Q000150:complications / Q000175:diagnosis; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D010808:Physical Examination / Q000295:instrumentation* / Q000379:methods; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology*; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000209:etiology*