Utility of pelvic examination in assessing women with bleeding in early pregnancy: a multicenter Canadian emergency department study

Utility of pelvic examination in assessing women with bleeding in early pregnancy: a multicenter Canadian emergency department study

Pelvic examination, Emergency department, Pregnancy, Management, Miscarriage, Bleeding in early
pregnancy, Diagnostic utility

Abstract
Background Bleeding in early pregnancy is a common emergency department (ED) presentation. Although
variability in approaches has been demonstrated, research is relatively uncommon on practices and outcomes. This
study investigated the influence of clinical pattern of care, utility, and contribution of pelvic examination aimed at
diagnosing and managing bleeding in early pregnancy at three Canadian EDs.
Methods After obtaining informed consent, data were collected from adult women who were pregnant and
from treating ED physicians using a structured questionnaire. We defined the change in management based on the
initial clinical plan at the time of the initial physician assessment in the ED and any subsequent changes made after
the pelvic examination was performed. Patient telephone follow-up was supplemented by linking with provincial
administrative data for births. Univariable and multivariable binary logistic regression analyses were performed to
identify factors associated with a change in patient management following pelvic examination in the ED.
Results Overall, 200 women were enrolled. The mean age was 31 years, patients had been bleeding for a median
of 1 day and stayed in the ED for a median of 5 h. Of these, 166 (83.0%) received a pelvic examination, including
speculum examination and/or bimanual palpation. Pregnancy outcome data were available for 192 pregnancies;
107 (56%) experienced a miscarriage. Factors significantly associated with a change in management after pelvic
examination in the univariate logistic regression analysis were brown/dark-red bleeding per vaginam (physician
determined), tachycardia, right lower quadrant tenderness, and bimanual palpation. In the multivariate logistic
regression analysis, brown/dark-red bleeding per vaginam was independently associated with a reduced likelihood of
a change in management after pelvic examination (aOR=0.37; 95% CI: 0.14–0.98).
Conclusion Among women presenting to the ED with bleeding in early pregnancy prior to 20 weeks gestation,
only brown/dark-red vaginal bleeding, potentially indicative of bleeding resolution, significantly independently
influenced the baseline odds of a change in management after pelvic examination. Until the debate on the utility
of pelvic examination in the ED for this presentation is resolved, physician preferences and shared decision making

Steven Fisher1

, Stephanie Couperthwaite1

, Esther H. Yang1,2, Nana Owusu Mensah Essel1

and Brian H. Rowe1,3*

https://doi.org/10.1186/s12245-024-00686-2

2024

Peri Irawan

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