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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1171-1177 • 0278-4297

Prospective Comparative Trial of Endovaginal Sonographic Bimanual Examination Versus Traditional Digital Bimanual Examination in Nonpregnant Women With Lower Abdominal Pain With Regard to Body Mass Index Classification

Vivek S. Tayal, MD, Christopher A. Crean, MD, H. James Norton, PhD, Christian J. Schulz, PA-C, Katrina N. Bacalis, PA-C and Susan Bliss, MD

Departments of Emergency Medicine (V.S.T., C.A.C., C.J.S., K.N.B.), Biostatistics (H.J.N.), and Obstetrics and Gynecology (S.B.), Carolinas Medical Center, Charlotte, North Carolina USA. Dr Crean is now with the Department of Emergency Medicine, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts USA.

Address correspondence to Vivek S. Tayal, MD, Department of Emergency Medicine, Carolinas Medical Center, Box 32861, Charlotte, NC 28232 USA. E-mail: vtayal{at}carolinas.org

Objective. We hypothesized that a sonographic bimanual examination (SBME) would improve confidence in the pelvic examination in adult nonpregnant women with lower abdominal conditions compared to a traditional digital bimanual examination (DBME). Methods. In a prospective comparative study at an urban regional emergency department, an ultrasound-trained group of emergency clinicians performed both an SBME and a DBME on 30 women who required a DBME as part of their evaluation. Patients were divided into 3 groups based on their body mass index (BMI) weight class. Inclusion criteria included lower abdominal pain, age between 18 and 55 years, hemodynamic stability, and BMI of greater than 18.5. Exclusion criteria included pregnancy, hysterectomy, oophorectomy, and recent vaginal surgery. The patient’s sequence of examinations was randomized and then performed by a different member of the study group. Examiners assessed their confidence (0%–100%) in 11 components of the pelvic examination. Results. There were higher scores for the SBME compared to the DBME in the overall composite score, cervical position, uterine size, uterine position, uterine tenderness, ovarian size, ovarian tenderness, and presence of an adnexal mass (P < .05), whereas cervical motion tenderness, cervical os opening, and rectovaginal tenderness did not show significant differences. Across BMI classes, the SBME produced high composite and individual examination scores among all examination criteria. In contrast, the DBME revealed significant differences for uterine size, uterine alignment, uterine tenderness, ovarian size, and ovarian tenderness across BMI classes (P < .05). Conclusions. The SBME provides improved confidence in overall and key aspects of the pelvic examination across BMI classes compared to the DBME.

Key Words: body mass index • bimanual • pelvic • sonographic • ultrasound

Abbreviations: BMI, body mass index • DBME, digital bimanual examination • ED, emergency department • SBME, sonographic bimanual examination

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.