• R Hoey and K Allan.
• Accident and Emergency Department, Chelsea and Westminster Hospital, London, UK. rachelhoey@hotmail.com <rachelhoey@hotmail.com>
• Emerg Med J. 2004 Jul 1; 21 (4): 461-3.

ObjectivesTo 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.MethodA 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.Results236 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.ConclusionThe 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.

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