Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial

Wittels, 2008, United States emergency department visits for vaginal bleeding during early pregnancy, 1993-2003, Am J Obstet Gynecol, 198, 523.e1, 10.1016/j.ajog.2007.11.011 Washbourne, 2002, Per vagina (PV) bleeding in early pregnancy, Emerg Nurse, 10, 21, 10.7748/en2002.12.10.8.21.c1087 Dart, 1999, Predictive value of history and physical examination in patients with suspected ectopic pregnancy, Ann Emerg Med, 33, 283, 10.1016/S0196-0644(99)70364-1 Heaton, 2016, Ectopic pregnancy and emergencies in the first 20 weeks of pregnancy, 628 Isoardi, 2009, Review article: the use of pelvic examination within the emergency department in the assessment of early pregnancy bleeding, Emerg Med Australas EMA, 21, 440, 10.1111/j.1742-6723.2009.01227.x Hahn, 2012, Clinical policy: critical issues in the initial evaluation and management of patients presenting to the emergency department in early pregnancy, Ann Emerg Med, 60, 381, 10.1016/j.annemergmed.2012.04.021 Buckingham, 1999, Management of vaginal bleeding presenting to the accident and emergency department, J Accid Emerg Med, 16, 130, 10.1136/emj.16.2.130 Gilling-Smith, 1994, Management of bleeding in early pregnancy in accident and emergency departments, BMJ, 309, 574, 10.1136/bmj.309.6954.574a Hsu, 2010, Correspondence to “pelvic examination is unnecessary in pregnant patients with a normal bedside ultrasound” (Feb 28:213-6), Am J Emerg Med, 28, 532, 10.1016/j.ajem.2010.03.027 Johnstone, 2013, Vaginal examination does not improve diagnostic accuracy in early pregnancy bleeding, Emerg Med Australas, 25, 219, 10.1111/1742-6723.12068 Brown, 2003, Medical myth: bimanual pelvic examination is a reliable decision aid in the investigation of acute abdominal pain or vaginal bleeding, CJEM, 5, 120, 10.1017/S1481803500008289 Close, 2001, Reliability of bimanual pelvic examinations performed in emergency departments, West J Med, 175, 10.1136/ewjm.175.4.240-a Padilla, 2000, Accuracy of the pelvic examination in detecting adnexal masses, Obstet Gynecol, 96, 593 Brown, 2011, Does pelvic exam in the emergency department add useful information?, West J Emerg Med, 12, 208 Seymour, 2010, Pelvic examination is unnecessary in pregnant patients with a normal bedside ultrasound, Am J Emerg Med, 28, 213, 10.1016/j.ajem.2008.10.018 Walker, 2010, Understanding equivalence and noninferiority testing, J Gen Intern Med, 26, 192, 10.1007/s11606-010-1513-8 Mol, 1999, Should patients who are suspected of having an ectopic pregnancy undergo physical examination?, Fertil Steril, 71, 155, 10.1016/S0015-0282(98)00396-3 Houry, 2013, Acute complications of pregnancy, Vol 2, 2282 Heaton, 2015, Ectopic pregnancy and emergencies of the first 20 weeks of pregnancy, 628