title: Impact of the availability of sonography in the acute gynecology unit.
abstract: OBJECTIVE
  The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient.
  
  
  METHODS
  This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared.
  
  
  RESULTS
  We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%).
  
  
  CONCLUSIONS
  It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.
authors.affiliation: Acute Gynaecology Unit, St. George's Hospital, London, UK. zara.marsh@tesco.net
authors.forename: Z
authors.initials: Z
authors.lastname: Haider
authors.forename: G
authors.initials: G
authors.lastname: Condous
authors.forename: A
authors.initials: A
authors.lastname: Khalid
authors.forename: E
authors.initials: E
authors.lastname: Kirk
authors.forename: F
authors.initials: F
authors.lastname: Mukri
authors.forename: B
authors.initials: B
authors.lastname: Van Calster
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000592:standards; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D005831:Genital Diseases, Female / Q000000981:diagnostic imaging*; D006801:Humans; D008131:London; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D014463:Ultrasonography