brand logo

Am Fam Physician. 1998;58(8):1892

Up to 40 percent of women of reproductive age in the United States develop uterine leiomyomas. This condition is reported to be the principal indication for approximately one third of all hysterectomies. The size of the uterus is the major determinant of symptoms, probability of surgery and choice of surgical procedure. The traditional assessment of uterine size relies on bimanual examination. Ultrasound examination is commonly used to confirm bimanual assessments, but it is not clear if ultrasound studies add to clinical information. Cantuaria and colleagues compared bimanual and ultrasonographic assessment of uterine size in patients with leiomyomas to clarify the role of ultrasonography.

A total of 111 women who underwent ultrasound examination before hysterectomy for uterine leiomyomas were retrospectively studied. Before the ultrasound examination, uterine size was estimated by bimanual examination performed by a senior resident and confirmed by an attending physician. The results of the bimanual examination were reported in terms of equivalent gestational size. Uterine dimensions on ultrasound were converted to equivalent gestational size using an established formula. Each uterus was weighed and measured after surgery.

On bimanual examination, uterine size estimations ranged from six to 25 weeks. In four patients, bimanual estimations were not possible because of obesity. The correlation between bimanual and ultrasound estimations was highly significant. Body mass index did not influence this correlation. Both bimanual and ultrasound estimates correlated with the actual size of pathologic specimens.

The authors conclude that routine ultrasound examination is not indicated when bimanual assessment of uterine leiomyomas is performed by an experienced examiner. Ultrasonography may provide useful information when bimanual examination and assessment are difficult, as in the case of extremely obese patients.

Continue Reading

More in AFP

Copyright © 1998 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.