RT Journal Article
SR Electronic
T1 Open-access transvaginal sonography in women of reproductive age with abnormal vaginal bleeding: a descriptive study in general practice
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e340
OP e346
DO 10.3399/bjgp11X578016
VO 61
IS 587
A1 Corlien JH de Vries
A1 Margreet Wieringa-de Waard
A1 Patrick JE Bindels
A1 Willem M Ankum
YR 2011
UL http://bjgp.org/content/61/587/e340.abstract
AB Background Diagnostic ultrasonography is used by GPs in approximately 10% of patients of reproductive age with abnormal vaginal bleeding. Transvaginal sonography is recommended as a first-line diagnostic instrument for assessing uterine pathology.Aim To assess if findings resulting from openaccess sonography were in agreement with the GPs’ working hypotheses and if these findings contributed to GPs’ management.Design and setting Prospective observational cohort study of GPs working in the health district of the Academic Medical Center, Amsterdam and their patients consulting with abnormal vaginal bleeding.Method Data on patients’ history, GPs’ primary working hypotheses, and intended management were recorded. After sonography, GPs recorded their actual management.Results A total of 122 patients were included by 18 GPs from June 2003 to December 2004. Data from 89 patients were available for analysis. The GPs’ working hypotheses implied ‘no structural pathology’ in 65/89 patients, and ‘fibroids’ in 24/89 patients. Sonographic findings were confirmed in 50/65 patients where ‘no structural pathology’, and in 14/24 of those where ‘fibroids’ were expected. Initially, GPs had intended to refer nine patients to a gynaecologist. Actual management after sonographic assessment was watchful waiting or drug therapy in 57/89 patients. Eighty-nine per cent of these patients had normal sonographic findings. The actual referral rate rose to 27/89 patients. In 17 referred patients, sonographic findings were suggestive of intracavitary abnormalities.Conclusion Open-access sonography contributed to more accurate diagnoses and improved GPs’ management of women with abnormal vaginal bleeding.