POAC Pelvic Ultrasound Policy
For Pelvic Ultrasound Scan
POAC funds acute pelvic ultrasound scans for the following conditions (where required within 24-48 hrs).
Note: For Abnormal Uterine Bleeding (AUB) or Post Menopausal Bleeding (PMB) see pathway here. Auckland/Waitemata USS request via eReferral/ATD. For Counties Manukau patient requests, contact POAC for non-urgent community ultrasound.
1. ULTRASOUND DURING OR FOLLOWING PREGNANCY:
Note that Section 88 maternity funding covers the cost of ultrasound scans performed within 2 weeks following miscarriage or termination of pregnancy, or within 6 weeks post-delivery.
USS within the Section 88 funded scan time period.
POAC does not fund the cost of a pelvic USS within the Section 88 funded scan time period.
POAC does (where the alternative is hospital presentation, and scanning in the community is safe):
a. facilitate the arrangement of scans, on request
b. fund the co-payment, where this would be a barrier to community scanning
See more information on obstetric ultrasound access in Counties Manukau here.
1a. SUSPECTED ECTOPIC PREGNANCY:
POAC will only facilitate arrangements and fund co-payment for a community ultrasound for the purpose of excluding ectopic pregnancy IF it has been discussed with and approved by a hospital Gynaecologist, AND an appointment can be arranged the same day.
Include the name of the recommending clinician with the clinical notes provided to POAC (see HealthPathways: Pain and Bleeding in Early Pregnancy)
1b. RETAINED PRODUCTS OF CONCEPTION:
POAC funds USS after miscarriage or termination of pregnancy to rule out retained products of conception when PV bleeding is:
● persistent lasting more than 12 hours), AND
● heavy (1 to 2 pads every hour)
For persistent but lighter bleeding a scan should be requested under Access to Diagnostics or via e-referral to radiology.
• Suspected Pelvic Collection related to Pelvic Inflammatory Disease (PID)
Patients with symptoms and signs suggestive of pelvic infection who do not have an acute abdomen or sepsis necessitating admission but either:
• Do not respond to treatment as detailed in the guidelines for the management of PID (see HealthPathways: Pelvic Inflammatory Disease) within 3 days; or
• Have findings on examination suggestive of adnexal mass (relevant findings must be documented)
Suspected Pelvic Collection related to surgical procedures
After discussion with and endorsement by the relevant speciality, POAC will fund an acute ultrasound to rule out suspected pelvic collection
2. LOST IUCD STRINGS:
If IUCD strings not visible and IUCD due for removal, it is reasonable to first attempt to remove the device. This can be done with a pair of long-handled forceps placed into the cervical canal. The majority of the time the strings will be sitting in the cervical canal. If successful this eliminates the need for an ultrasound scan.
POAC will fund a scan for lost IUCD strings in a patient with significant pain where:
- the device cannot be removed by cervical canal instrumentation as described above; or
- device removal is not desirable
Without pain order a non-urgent scan through ATD or DHB e-Referrals
3. ACUTE PELVIC PAIN OF UNCLEAR CAUSE AFTER ASSESSMENT IN ED (pregnancy test negative)
POAC funds pelvic USS following ED assessment of acute pelvic pain where hospital admission may be avoided or length of stay shortened if a rule-out/rule-in scan can be obtained quickly.
In primary care, following assessment, provide analgesia to provide pain relief within 30 minutes. See Auckland Regional HealthPathway Acute Pelvic Pain in Young Women for analgesia recommendations.
If pain settles organise a pelvic scan (if indicated) using ATD or e-referrals.
POAC does not fund pelvic ultrasound for pelvic pain in any other circumstances.
POAC does not fund pelvic ultrasound for the following clinical conditions:
- Pregnancy-related pain
- Patients with evidence of an acute abdomen: refer to hospital ED (surgery, gynaecology). This includes suspected ovarian torsion, which presents as an acute abdomen. See also POAC Appendicitis policy.
- Patients with suspicion of “imminent” ovarian torsion (episodes suggestive of torsion/de-torsion): refer to hospital.
- Patients with pelvic pain of unknown cause (no symptoms and signs suggestive of infection, no acute abdomen, and pregnancy test negative) whose pain cannot be sufficiently controlled in the community: refer to hospital (surgery, gastroenterology, gynaecology).
- To visualise a suspected simple ovarian cyst
For publicly funded pelvic scans for other suspected diagnoses, patients should be referred under Access to Diagnostics (Auckland, Counties Manukau) or via e-Referrals to the local hospital radiology department (Auckland, Waitemata).