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Abdominal versus vaginal ultrasoundFrom: dahmd@gate.netSun Nov 24 22:24:44 1996
Colleagues- A patient of mine presented to the emergency department (ED) one night complaining of light vaginal bleeding at 6 weeks gestational age. She was concerned about a possible miscarriage. The ED doctor ordered a pelvic ultrasound as part of the work-up, but the patient, who has a medical background, refused the foley catheter and abdominal ultrasound. Instead, she asked for a vaginal ultrasound. The radiologist on call demanded that an abdominal scan (with foley catheter in place) be performed first, followed by a vaginal ultrasound to "make sure that nothing is missed." I have found this unusual, and I think faulty, logic at every hospital I have been to. The radiologists claim that some things can be missed by vaginal ultrasound and that it's the standard of care to perform both an abdominal, and then a vaginal, ultrasound. Why put the patient through the discomfort of the catheter with a full bladder, and the (probably small) risk of urinary tract infection when doing an abdominal scan when a vaginal ultrasound is much better at providing information with a 6 week pregnancy? The radiologist seemed to think I was out of my mind for suggesting he bypass abdominal scans on all my future patients with similar complaints. Any thoughts from the group? Thanks, Ashley D. Ashley Hill, M.D. dahmd@gate.net Orlando, Fl
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