The role of ultrasound in gynecological emergencies.
The expanding use of ultrasonography in gynecology puts increasing strain on the resources of ultrasound departments; any mechanism to increase the diagnostic efficiency of the scan and reduce unwarranted investigation would, therefore, be welcome. This prospective study examines the use of abdominal ultrasound examination in gynecological emergencies over a 6-month period in a London teaching hospital. The examination changed the clinical management in 33% of cases where the pregnancy test was positive, but in only 14% where it was negative. In the former group, the confirmation of viable intrauterine pregnancy reassured both patient and clinician in 84% of the cases, making the test a useful investigation in 89% of the total cases where the pregnancy test was positive. When the pregnancy test was negative, the ultrasound scan was more likely to be useful if requested by doctors with gynecological experience. In cases of incomplete spontaneous abortion, ultrasound was not found to be a useful investigation. Access to ultrasound equipment by, and basic ultrasound training of admitting junior doctors with gynecological experience would reduce referrals to the ultrasound department and reduce admissions to hospital, whilst improving appreciation of the role of ultrasound in gynecological emergencies.