What are the key indications for requesting an ultrasound scan in primary care?

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) ¹.
• 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 ¹.
• Women with symptoms or signs suggestive of ectopic pregnancy (e.g., pain, bleeding, or worsening symptoms) should be referred for ultrasound assessment ¹.
• 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 ².
• Unexplained vaginal discharge or visible haematuria in women aged 55 and over may warrant a direct access ultrasound scan to assess for endometrial pathology ².
• 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 ².

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 ¹.