For patients who did not undergo laparoscopy and before discharge, a routine time of observation of about 24 hours is usually performed in the department of gynecology. Data collection The physical examination included palpation of the abdomen, speculum Selleck Epoxomicin examination, and digital vaginal examination. The results were considered normal when there was no guarding, rebound, mass, or thickening on abdominal
palpation 2 5 16 and no cervical motion tenderness, adnexal tenderness, or adnexal mass or thickening on vaginal examination [4, 16]. If one of these features was present, the physical examination was considered abnormal. TVUS was performed using a 3.5-5 MHz transabdominal probe and a 7 MHz transvaginal probe with a General Electric Voluson 730 Expert machine (GE Medical System Europe). The residents followed a standardized TVUS protocol including at least five images,
and including a routinely recording of: (i) a longitudinal view of the uterus to visualize the midline stripe indicating an empty uterus, (ii) a transverse view of the uterus, (iii and iv) a view of each ovary with the transvaginal probe, and (v) a view of Morison’s pouch with the transabdominal probe (Figure 1). One to three additional views could be obtained as dictated by MK2206 the abnormal ultrasound findings (e.g., view of an ectopic gestational sac) . Residents received a 1-hour class taught by a board-certified senior obstetrician/gynecologist with special expertise in gynecological ultrasonography available online (http://www.e-campus.uvsq.fr/claroline/course/index.php?cid=SAFE). This
class covered image acquisition, Carnitine dehydrogenase normal and abnormal findings and image quality criteria. A copy of the written protocol for bedside emergency ultrasonography was also given to each resident. Figure 1 Standardized ultrasonography scans. (i) longitudinal view of the uterus, (ii) transverse view of the uterus, (iii) view of left ovary, and (iv) view of Morison’s pouch. For the present study, all sonograms were retrospectively re-interpreted by two authors: a board-certified obstetrician/gynecologist (FTL) with special expertise in gynecological ultrasonography and a research nurse (AC), who were blinded to the physical and laparoscopic findings. TVUS was considered abnormal if any of the following was seen: pelvic fluid reaching the uterine corpus or around the ovary , fluid in Morison’s pouch , abnormal adnexal mass separate from the ovary [10, 19], and ovary larger than 50 mm and containing a cyst . Key outcome measures The laparoscopy diagnosis was the reference standard. Patients were classified as having a surgical emergency or a benign emergency. Surgical emergencies were defined as gynecologic or nongynecologic disorders diagnosed by laparoscopy and associated with a high risk of complications likely to cause severe morbidity or death in the absence of appropriate emergency surgical treatment .