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| I. Obstretrics and gynaecology | |||||||
| N.B. Transvaginal US equipment should be available in all departments performing pelvic US | |||||||
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CLINICAL/DIAGNOSTIC PROBLEM |
INVESTIGATION |
RECOMMENDATION (GRADE) |
COMMENT |
DOSE |
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Screening in pregnancy |
US |
Indicated (B) |
Screening in early pregnancy (9-13 weeks) accurately dates a pregnancy by measuring the total crown-rump length. This reduces the intervention rate for infants born at or after full term. US accurately assesses fetal number and chorionicity and improves outcome for multiple pregnancies. Screening for structural abnormality at 18-20 weeks has not been shown to alter perinatal mortality except where selective termination of pregnancy is applied in the presence of gross fetal abnormality. US has proven value in assessing placenta praevia and intrauterine growth restriction. In the specialist care of high-risk pregnancies, Doppler US is essential for the safe practice of intervention and therapeutic procedures such as amniocentesis, fetal blood sampling, and transfusions during pregnancy. |
0 |
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| Suspected pregnancy | US | Indicated only in specific circumstances (B) | There is no indication that diagnosing pregnancy by US, other than for dating, is appropriate. If early pregnancy is symptomatic, e.g. pain or vaginal bleeding, US is indicated. Pregnancy testing is the most appropriate test. | II | |||
| Suspected ectopic pregnancy | US | Indicated (B) | After a positive pregnancy test. Transvaginal US is most accurate. Colour Doppler increases sensitivity. | 0 | |||
| Possible non-viable pregnancy | US | Indicated (C) | Pregnancy test is required. Repeat US after a week may be needed (especially when gestation sac <20 mm or crown-rump length < 6 mm). Where doubt exists about viability of a pregnancy, delay in evacuation of the uterus is essential. | 0 | |||
| Uterus: body | |||||||
| Post-menopausal Bleeding: to exclude significant endometrial pathology | US | Indicated (B) | Transvaginal US is indicated to exclude significant endometrial pathology in post-menopausal bleeding. Endometrial thickness > 5 mm requires biopsy for specific diagnosis. | 0 | |||
| Suspected pelvic mass | US | Indicated (C) | Combination of transabdominal and transvaginal US is often required. US should confirm the presence of a lesion and determine the likely organ of origin. Transvaginal scanning should be used to define the anatomy further. MRI is the best second-line investigation, although CT is still widely used. | 0 | |||
| Pelvic pain, including suspected pelvic inflammatory disease and suspected endometriosis | US | Indicated (C) | Especially
when clinical examination is difficult or impossible. US has a poor
predictive power when diagnosing pelvic inflammatory disease. |
0 | |||
| MRI | Specialised investigation (B) | Can be useful to localise the larger foci of endometriosis. | 0 | ||||
| Lost IUCD | US | Indicated (C) | To confirm or refute the presence of the IUCD in uterus. | 0 | |||
| AXR | Indicated only in specific circumstances (C) | Indicated only when IUCD is not seen in uterus on US | I-II | ||||
| Recurrent miscarriages | US | Indicated (C) | Will show the major uterine congenital and acquired problems and is useful to identify polycystic ovaries. | 0 | |||
| MRI | Specialised investigation | Supplements US for uterine anatomy. | 0 | ||||
| Infertility | US | Indicated (C) | For follicle tracking during treatment. For assessment of tubal patency, US is not yet widely practised. Some centres use MRI and /or laparoscopy and/or hysterosalpingography. | 0 | |||
| Suspected cephalopelvic disproportion | XR pelvimetry | Not indicated (B) | The need for pelvimetry is increasingly being questioned. Local policy should be determined in agreement with obstetricians. MRI or CT should be used whenever possible | II | |||
| MRI/CT | Specialised investigation (C) | MRI is best as it avoids x-irradiation. CT generally offers a lower dose than standard XR pelvimetry. | 0-I | ||||
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