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Re: Endovaginal in 1st trimesterFrom: James S Smeltzer MD (gaperina@mindspring.com)Fri Mar 6 07:46:19 1998
At 08:18 AM 3/6/1998 -0600, you wrote: >I had received a private email from one of the ob/gyn's concerning >endovaginal only scans. He brought forth a point that the doctor not >only does sonography but also an internal exam which should 'feel' a >mass that high in the pelvis. Since sonographers don't have this option >full bladder technique and endovaginal should r/o missing a mass. > The endovaginal "miss" I referred to was also missed by me and by my department chairman (An OUTSTANDING gynecologist) in a medium heavy patient, one of two times. It was a borderline tumor serous cystadeno (Ca Grade 0), encapsulated & one side only. It was also missed on the first Abdominal scan (Looked like the bladder in front of the uterus). As a gynecologist, I do a bimanual scan [abdominal scan with vaginal or rectovaginal] exam a couple of times per week & it helps. I firmly believe & have taught residents in OB&GYN that US is rightfully an essential part of their basic armamentarium: In general with maintenance of decent ultrasound skills they can take better care of the patient than a gynecologist that cannot scan & sonographer that does not know intimately the clinical story & problem involved. I know others who have used TVS to teach pelvic exams & claim that the learning curve is a lot better with this kind of feed-back. I believe it! Jim Smeltzer :-)>
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