PELVIC ULTRASONOGRAPHY - 10/09/11

Doi : 10.1016/S0733-8627(05)70334-5

Mary Beth Phelan, MD, RDMS ^{^{*
From the Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin}}, Verena T. Valley, MD, RDMS ^{^{*
From the Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin}}, James R. Mateer, MD, RDMS ^{^{*
From the Medical College of Wisconsin, Department of Emergency Medicine, Milwaukee, Wisconsin}}

Résumé

Pelvic ultrasonography is a necessary tool in the complete evaluation of many lower abdominal complaints in women. In the practice of emergency medicine, this technology has had a great impact on the evaluation of complaints in early pregnancy, such as vaginal bleeding and lower abdominal pain. Bedside pelvic ultrasonography performed and interpreted by emergency physicians early in the evaluation of these patients has several advantages. A transabdominal (TAS) or endovaginal ultrasound (EVS) study can rapidly be incorporated into the initial evaluation. The patient does not need to be moved, and information gathered is immediately available. The differential diagnosis is narrowed by excluding or including certain diagnosis. Such improved diagnostic accuracy allows emergency physicians to reach critical decision points early in the patient evaluation process, resulting in a more expeditious emergency department (ED) disposition.^{70 Timor-Tritsch I., Rottem S., Lewit N. The fallopian tubes Transvaginal Sonography New York: Elsevier (1991).
131-134

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Using bedside EVS, early detection of ectopic pregnancy by emergency physicians has resulted in decreased morbidity.^{38 Mateer J.R., Valley V.T., Aiman E.J. , et al. Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy Ann Emerg Med 1996 ; 27 : 283-289 [cross-ref]

Cliquez ici pour aller à la section Références} When ectopic pregnancy is diagnosed early, conservative management (medical or surgical) is possible, allowing for optimal outcome.^{10 Cacciatore B., Stenman U., Ylostalo P. Early screening for ectopic pregnancy in high-risk symptom-free women The Lancet 1994 ; 343 : 517-518 [cross-ref]

Cliquez ici pour aller à la section Références, 11 Carson S.A., Buster J.E. Ectopic pregnancy N Engl J Med 1993 ; 329 : 1174-1181 [cross-ref]

Cliquez ici pour aller à la section Références} Pelvic ultrasonography is invaluable in the rapid assessment of fetal well-being after trauma and the evaluation of the pregnant trauma patient. In the second- and third-trimester trauma patient, ultrasonography has been recommended for fetal evaluation during the initial resuscitation phase.^{20 Early pregnancy Transvaginal Ultrasound New York: Churchill Livingstone (1991).
165-200

Cliquez ici pour aller à la section Références} Ultrasonography may be useful for the evaluation of patients with vaginal bleeding during the second and third trimester of pregnancy.^{24 Fleischer A.C., Kepple D.M. Normal pelvic anatomy: What you can expect to see Endovaginal Ultrasound New York: Alan R. Liss (1989).
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Cliquez ici pour aller à la section Références} Finally, ultrasonography plays a role in the diagnosis of pelvic inflammatory disease (PID) and adnexal masses.^{8 Bulas D.I., Ahlstrom P.A., Sivit C.J. , et al. Pelvic inflammatory disease in the adolescent: Comparison of transabdominal and transvaginal sonographic evaluation Radiology 1992 ; 183 : 435-439

Cliquez ici pour aller à la section Références, 9 Cacciatore B., Leminen A., Ingman-Fribert S. , et al. Transvaginal sonographic findings in ambulatory patients with suspected pelvic inflammatory disease Obstet Gynecol 1992 ; 80 : 912-916

Cliquez ici pour aller à la section Références, 28 Hata K., Hata T., Aoki S. , et al. Ultrasonographic evaluation of pelvic inflammatory disease Acta Obstet Gynaecol Jpn 1989 ; 41 : 895-898

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Pelvic ultrasonography is a valuable tool for the emergency physician to use in the evaluation of patients presenting with lower abdominal/pelvic pain. Several studies have shown pelvic ultrasound examinations to be accurate when performed by emergency physicians to help rule out ectopic pregnancy.^{37 Mateer J.R., Aiman E.J., Brown M.H. , et al. Ultrasonographic examination by emergency physicians of patients at risk for ectopic pregnancy Acad Emerg Med 1995 ; 2 : 867-873 [cross-ref]

Cliquez ici pour aller à la section Références, 38 Mateer J.R., Valley V.T., Aiman E.J. , et al. Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy Ann Emerg Med 1996 ; 27 : 283-289 [cross-ref]

Cliquez ici pour aller à la section Références} The goal of this article is to outline pelvic problems that can be readily identified by the emergency physician using pelvic sonography early in the patient's evaluation. A special emphasis is placed on the sonographic diagnosis of ectopic pregnancy.

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Plan

Address reprint requests to Mary Beth Phelan, MD, RDMS, Department of Emergency Medicine, 9200 West Wisconsin Avenue, Froedtert East, Milwaukee, WI 53226