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  7. Indications for speculum examination in early pregnancy, Gynaecology (1114)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

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

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 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

 

 

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