Skip to main content
  1. Right Decisions
  2. GGC - Clinical Guidelines
  3. Gynaecology
  4. Back
  5. Gynaecology guidelines
  6. Indications for speculum examination in early pregnancy, Gynaecology (1114)
Announcements and latest updates

Right Decision Service newsletter: October 2024

Welcome to the Right Decision Service (RDS) newsletter for October 2024.

1.Contingency arrangements for RDS outages

Development of the contingency solutions to maximise RDS resilience and minimise risk of future outages is in progress, aiming for completion by Christmas. As a reminder, these contingency arrangements  are:

  • Optimising mobile app build process
  • Mobile app always to be downloadable.
  • Serialising builds to mobile app; separate mobile app build from other editorial and end-user processes
  • Load balancing – provides failover (also enables separation of editorial processes from other processes to improve performance.)

 

In the meantime, a gentle reminder to encourage users to download essential clinical toolkits to their mobile devices so that there is an offline version always available.

 

2. New deployment with improvements.

A new scheduled deployment with minor improvements drawn from support tickets, externally funded projects, information related to outages, and feature requests will take place in early December. Key improvements planned are:

  • Deep-linking to individual toolkits within the RDS mobile app. Each toolkit will now have its own direct URL and QR code, both accessible from the app. These can be used to download the toolkit directly where users already have the RDS app installed. If the user does not yet have the RDS app installed, they will be taken to the app store to install the app and immediately afterwards the toolkit will automatically open and download. Note that this will go live a few days later than the improvements below due to the need to link up the mobile front end to the changes in the content management system.
  • Introducing an Announcement Header field to replace the hardcoded "Announcements and latest updates" text. This will enable users to see at a glance the focus of new announcements.
  • Automated daily emptying of the recycling bin (with a 30 day rolling grace period)  in the content management system. A bug preventing complete emptying of the recycling bin contributed to one of the outages earlier this year.
  • Supporting multiple passcodes (ticket 6079)
  • Expanding accordion section to show location of a search result rather than requiring user coming from a search result to manually open all sections and search again for the term.
  • Displaying first accordion section Content text as a snippet on the search results page as a fallback if default/main content is not provided
  • Displaying the context of each search result in the form of a link to the relevant parent tool/section. This will help users to choose which search result is most likely to be appropriate for their needs.
  • As part of release of the new national benzodiazepine quality prescribing guidance toolkit sponsored by Scottish Government Effective Prescribing and Therapeutics, a digital tool to support creation of benzodiazepine tapering/withdrawal schedules.

We are also seeking approval to use the NHS Scotland logo and title for the RDS app on the app stores to help with audience engagement and clarity around the provenance of RDS.

3. RDS Search, Browse and Archive/Version control enhancements

We are still hopeful that user acceptance testing for at least the Search and browse enhancements can take place before Christmas. Thank you for your patience and understanding in waiting for these improvements. Timescales have been pushed back by old app migration challenges, work to address outages, and most recently implementing the contingency arrangements.

4. Support tickets

We are aware that there continue to be some issues around a number of RDS support tickets, in part due to constraints around visibility for the RDS team of the tickets in the existing  support portal. We are investigating the potential to move to a new support ticket requesting system from early in the new year. We will organise the proposed webinar around support ticket processes once we have confirmed the way forward with the system.

Table formatting

There is a known issue with alterations in formatting of some RDS tables which seems to have arisen as a result of the 17 October deployment. Tactuum is working on a fix and on implementing additional regression testing to prevent this issue recurring.

5. New RDS toolkits

Recently launched toolkits include:

NHS Lothian Infectious Diseases

Scottish Health Technologies Group – Technology Assessment recommendations

NHS Tayside Anaesthetics and Critical Care projects – an innovative toolkit which uses PowerAutomate to manage review and response to proposals for improvement projects.

If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot

A number of toolkits are expected to go live before Christmas, including:

  • Focus on dementia
  • Highland Council Getting it Right for Every Child
  • Dumfries and Galloway Adult Support and Protection procedures
  • National Waiting Well toolkit
  • Fertility Scotland National Network
  • NHS Lothian postural care for care homes

6.Sign up to RDS Editors Teams channel

We have had a good response to the recent invitation to sign up to the new Teams channel for RDS editors. This provides a forum for editors to share learning, ideas and questions and we hope to hold regular webinars on topics of interest.  The RDS team is in the process of joining participants to the channel and we’d encourage all editors to take part, using the registration form – available in Providers section of the RDS Learning and Support area.

 

7. Evaluation projects

The RDS team has worked with colleagues in NHS Grampian and the Digital Health & Care Innovation Centre to evaluate the impact of the Prevent the progress of diabetes web and mobile app in a small-scale pilot project. This app provides access to local and national resources and services targeted at people with prediabetes, a history of gestational diabetes, or candidates for remission. After just 8 weeks of using the app, 94% of patients reported increased their knowledge and understanding of diabetes, and 88% said it had increased their confidence and motivation to make lifestyle changes, highlighting specific behaviour changes. The learning from this project is informing development of a service model based on tailored support for patient groups with, high, medium and low digital self-efficacy.

Please contact ann.wales3@nhs.scot if you would like to know more about this project.

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 29th November 3-4 pm
  • Thursday 5 December 3.30 -4.30 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

The Right Decision Service:  the national decision support platform for Scotland’s health and care

Website: https://rightdecisions.scot.nhs.uk    Mobile app download:  Apple  Android

 

 

Indications for speculum examination in early pregnancy, Gynaecology (1114)

Objectives

To provide guidance on when to perform speculum examination in women presenting with issues in early pregnancy

Scope

Women attending the early pregnancy service with vaginal bleeding

Audience

All healthcare professionals involved in the care of women in early pregnancy

Please report any inaccuracies or issues with this guideline using our online form

Bleeding is a common presentation in early pregnancy affecting approximately 20% of pregnancies in the first trimester. Whilst this bleeding is most commonly pregnancy related, it is important to remember that non pregnancy causes of bleeding can present for the first time in pregnancy.

There are number of possible causes for bleeding in early pregnancy including:

  • Implantation bleeding – commonly light spotting occurring at around the time of the missed period
  • Miscarriage – can range from light spotting to heavy/life threatening
  • Ectopic – can range from light to heavy
  • Molar pregnancy
  • Cervical ectropion or polyp – bleeding can be unprovoked or provoked such as following intercourse
  • Infection causing cervicitis
  • Trauma
  • Cancer of the cervix, vagina or vulva (rare)

Early Pregnancy Assessment Service (EPAS) management of early pregnancy bleeding

Miscarriage is the most common cause for early pregnancy bleeding, with ectopic pregnancy being an important second differential to be considered. As such any women presenting for the first time with vaginal bleeding >6 weeks gestation; vaginal bleeding with associated pain or ectopic risk factors at any gestation; or vaginal bleeding at an uncertain gestation should be assessed, ideally through local EPAS units.

This assessment should include an ultrasound scan to assess the location and viability of the pregnancy. If a miscarriage, ectopic or molar pregnancy is diagnosed on ultrasound scan these should be managed accordingly.

Women in whom a viable intrauterine pregnancy, with a fetal heartbeat, is confirmed should be advised that their risk of miscarriage falls to around 10% once the heartbeat has been detected. They should therefore be reassured and discharged, with advice to contact a midwife to book their pregnancy.  If the bleeding continues beyond 14 days, or restarts after stopping, women should be advised to re-contact EPAS for further assessment.

Indications for speculum examination

Indications for urgent speculum examination:

  • Heavy vaginal bleeding
  • Signs and symptoms suggestive of cervical shock – bradycardia and hypotension

In these circumstances resuscitation of the patient should be commenced while a member of staff trained and competent in speculum examination to remove products from the cervical os is contacted for urgent review.

Other indications for speculum examination:

  • Single episode of vaginal bleeding persisting >14 days
  • Presentation with a second episode with vaginal bleeding in pregnancy
  • Symptoms suggestive of infection eg. foul smelling PV discharge, vaginal itch
  • Ultrasound suggesting cervical ectopic - If cervical ectopic is suspected speculum should be performed by senior medical staff as findings will inform decisions regarding management.

In these circumstances speculum examination should be performed by a member of staff competent in assessing the vulva, vagina and cervix for abnormalities warranting further investigation.

Cervical Smear History

Cervical screening status should be assessed in all women presenting with bleeding in pregnancy.  If cervical screening history is uncertain and the patient is ≥25 years of age, the national database (SCCRS) may contain relevant information.

Opportunistic cervical smears should not be taken during pregnancy within the Obstetric Department.

Editorial Information

Last reviewed: 14/11/2023

Next review date: 31/10/2027

Author(s): Dr Alison Platten, Consultant O&G.

Version: 1

Approved By: Gynaecology Clinical Governance Group

Document Id: 1114