Do women with pain and bleeding in early pregnancy require a vaginal speculum examination as part of their assessment?
OBJECTIVE
To investigate whether a vaginal speculum examination (VSE) prior to a transvaginal scan (TVS) alters the diagnosis or management of women who complain of bleeding in early pregnancy.


METHODS
A prospective study. Women were asked to describe their bleeding as heavy, moderate or light and to consent to VSE prior to TVS. TVS was performed to obtain a final diagnosis of pregnancy outcome.


RESULTS
221 consecutive women were included in the study. In 14.5% (n = 32) complaining of heavy bleeding, blood was seen in all but two VSE and 84% (n = 27) had a miscarriage diagnosed by TVS. Products of conception were removed in 18.8% (n = 6), but this did not alter the subsequent immediate management of any cases. 65.2% (n = 144) of women complained of light bleeding, blood was seen on VSE in 53% (n = 77). Of these women, 25% (n = 19) of those where blood was seen had a miscarriage, compared to 6% (n = 4) of women where blood was not seen. A cervical ectropion was visualised in 11.7% (n = 26) and 2.3% (n = 5) had a cervical polyp. No other clinically significant pathology was detected.


CONCLUSIONS
The amount of bleeding reported by women in early pregnancy relates well with VSE findings. Performing a VSE did not alter the subsequent management of these patients. This study demonstrates that routine objective assessment of blood by a clinician performing VSE prior to a TVS is unnecessary.
Lister Fertility Clinic, Lister Hospital, London, UK.
Shabana A
SA
Bora
Emma
E
Kirk
Tom
T
Bourne
D000293:Adolescent; D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011261:Pregnancy Trimester, First; D011446:Prospective Studies; D013525:Surgical Instruments; D016216:Ultrasonography, Prenatal; D014621:Vagina / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult