Clinical examination has important role
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《英国医生杂志》
EDITOR—Threatened miscarriage is an excellent topic for your clinical review series,1 but it seems odd that Sotiriadis et al should almost entirely overlook the role of clinical examination, particularly in an article titled "evaluation and management." After a brief comment that thorough physical examination is essential to differentiate between genital and extragenital causes, the review moves directly from history to sonographic evaluation and maternal serum markers.
Many women with vaginal bleeding in early pregnancy present to primary and emergency services, where many of the investigations described in this review are not immediately available. The exact role and most appropriate type of physical examination is unclear,2 and would be worthy of inclusion in an article intended for generalist readership.
To overlook physical examination as a key part of patients' assessment is contrary to one of the fundamental principles of medicine: even if the authors think that it has a small part to play this should be clearly stated, and the issues discussed.
Jonathan R Benger, consultant in emergency medicine
Academic Department of Emergency Care, United Bristol Healthcare Trust, Bristol, BS2 8HW Jonathan.Benger@ubht.swest.nhs.uk
Competing interests: None declared.
References
Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management. BMJ 2004;329: 152-5. (17 July.)
Hoey R, Allan K. Does speculum examination have a role in assessing bleeding in early pregnancy? Emerg Med J 2004;21: 461-3.
Many women with vaginal bleeding in early pregnancy present to primary and emergency services, where many of the investigations described in this review are not immediately available. The exact role and most appropriate type of physical examination is unclear,2 and would be worthy of inclusion in an article intended for generalist readership.
To overlook physical examination as a key part of patients' assessment is contrary to one of the fundamental principles of medicine: even if the authors think that it has a small part to play this should be clearly stated, and the issues discussed.
Jonathan R Benger, consultant in emergency medicine
Academic Department of Emergency Care, United Bristol Healthcare Trust, Bristol, BS2 8HW Jonathan.Benger@ubht.swest.nhs.uk
Competing interests: None declared.
References
Sotiriadis A, Papatheodorou S, Makrydimas G. Threatened miscarriage: evaluation and management. BMJ 2004;329: 152-5. (17 July.)
Hoey R, Allan K. Does speculum examination have a role in assessing bleeding in early pregnancy? Emerg Med J 2004;21: 461-3.