Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key indications for requesting an ultrasound scan in primary care include:
- Suspected early pregnancy complications such as pain, bleeding, pregnancy of 6 weeks' gestation or more, or uncertain gestation to assess viability and location of pregnancy (e.g., to exclude ectopic pregnancy) NICE NG126.
- Women with bleeding but less than 6 weeks' gestation without pain or risk factors may initially be managed expectantly, with ultrasound considered if symptoms worsen or persist NICE NG126.
- Women with symptoms or signs suggestive of ectopic pregnancy (e.g., pain, bleeding, or worsening symptoms) should be referred for ultrasound assessment NICE NG126.
- Serum CA125 of 35 IU/ml or greater in women aged 18 and over to investigate possible ovarian pathology, prompting an abdominal and pelvic ultrasound scan NICE NG12.
- Unexplained vaginal discharge or visible haematuria in women aged 55 and over may warrant a direct access ultrasound scan to assess for endometrial pathology NICE NG12.
- Ultrasound is indicated when clinical suspicion of malignancy arises, such as ovarian cancer suggested by raised CA125 or abnormal clinical findings, to guide urgent referral NICE NG12.
Additional considerations: Transvaginal ultrasound is preferred for early pregnancy assessment, but transabdominal ultrasound may be used if transvaginal is unacceptable or if pelvic pathology such as fibroids or ovarian cysts is suspected NICE NG126.