Haider Z, Condous G, Khalid A, Kirk E, Mukri F, Van Calster B, Timmerman D, Bourne T
Acute Gynaecology Unit, St. George's Hospital, London, UK.
Ultrasound Obstet Gynecol. 2006 Aug;28(2):207-13. doi: 10.1002/uog.2801.
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.
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.
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%).
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.
急性妇科患者的初步评估通常基于病史和临床检查，并不涉及超声检查。本研究的目的是调查在急诊妇科患者初步评估时进行经阴道超声检查的影响。
这是一项在伦敦市中心一家教学医院的急性妇科病房进行的为期5个月的前瞻性观察性研究。通过病史采集和临床检查对女性进行常规评估，医生填写问卷，包括治疗意向的详细信息。然后进行经阴道超声检查，并利用扫描获得的额外信息制定第二个诊断和管理计划。比较超声检查前后的临床管理计划。
我们最初招募了1000名连续的女性参与研究。平均年龄为31.1（标准差，9.81）岁。920名（92%）女性有完整的数据。84名（9.1%）女性不需要扫描。在521名妊娠试验呈阳性的女性中，75.6%的人立即得到安心，确认其妊娠为宫内妊娠。143名女性（27.4%）在超声检查前被诊断为疑似异位妊娠，而在超声检查后这一比例为29名（5.6%）。超声检查后，54.1%妊娠试验呈阳性的女性临床管理发生了变化，住院率（包括住院手术率）降低（从40.3%降至17.1%），门诊随访检查率降低（从41.1%降至35.5%）。在90名（23.8%）非妊娠女性中，临床怀疑有较大卵巢囊肿（>5cm）；超声检查确诊其中28/90名（31.1%）。超声检查后，38.1%的非妊娠女性临床管理发生了变化，住院率降低（从37.1%降至19.4%），门诊随访检查率降低（从25.7%降至18.1%）。
在急诊妇科患者初步评估时进行经阴道超声检查似乎可提高诊断准确性，并减少不必要的住院和随访检查。
