Objective:The study aims to determine if a vaginal examination improves diagnostic accuracy when assessing women who present to the ED with vaginal bleeding in the first trimester of pregnancy.
Methods:One hundred and thirty-five women with first trimester bleeding were randomised to have a vaginal examination (n = 61) or not (n = 74). They were given a provisional diagnosis, and then a final diagnosis after ultrasound, beta-human chorionic gonadotropin and gynaecological follow up. The provisional diagnosis was considered accurate if it matched the final diagnosis.
Results:The provisional and final diagnoses matched in a little over half of the cases, and there was no statistical difference between the two groups (c 2 = 0.005, P = 0.94).
Conclusion:In a stable patient presenting to the ED with first trimester bleeding, clinical diagnosis is highly inaccurate and is not improved by vaginal examination. Routine vaginal examination is not necessary as part of the initial patient assessment.
THE increased popularity of female sterilisation in the last two decades has resulted in a greater awareness of failure. Vessey el af. (1 983) estimated that of every 1000 women undergoing tubal sterilisation, four will have conceived after 1 year, about eight after 4 years and about ten after 7 years. The causes of failure are pregnancy a t the time of surgery, inadequate surgery or recanalisation or fistula formation (Soderstrbm, 1985). At Dunedin Hospital there were 27 known failed sterilisations in the period 1974 to 1986. A number of these were known to be ectopic gestations. This prompted a study to identify both the type of failure and the risk factors for subsequent failure. J Obstet Gynaecol Downloaded from informahealthcare.com by McMaster University on 02/18/15 For personal use only.
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