Clinical Factors Affecting the Accuracy of Ultrasonography in Symptomatic First-Trimester Pregnancy

Barnhart, Kurt T.; Fay, C.; Suescum, M.; Sammel, Mary D.; Appleby, Dina; Shaunik, Alka; Dean, Anthony J.

doi:10.1097/aog.0b013e3182050ed0

Cited by 44 publications

(19 citation statements)

References 11 publications

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“…Among patients who did not undergo emergency laparoscopy, those who were pregnant were followed until a definitive diagnostic was made [17]. In nonpregnant patients, when the findings of all examinations were deemed normal and the pain subsided with appropriate analgesia by the end of the visit or hospitalization, a diagnosis of idiopathic acute pelvic pain was made.…”

Section: Methodsmentioning

confidence: 99%

Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology

et al. 2014

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ObjectiveAcute pelvic pain is a common reason for emergency room visits that can indicate a potentially life-threatening emergency (PLTE). Our objective here was to develop a triage process for PLTE based on a self-assessment questionnaire for gynecologic emergencies (SAQ-GE) in patients experiencing acute pelvic pain.MethodsIn this multicenter prospective observational study, all gynecological emergency room patients seen for acute pelvic pain between September 2006 and April 2008 completed the SAQ-GE after receiving appropriate analgesics. Diagnostic procedures were ordered without knowledge of questionnaire replies. Laparoscopy was the reference standard for diagnosing PLTE; other diagnoses were based on algorithms. In two-thirds of the population, SAQ-GE items significantly associated with PLTEs (P < 0.05) by univariate analysis were used to develop a decision tree by recursive partitioning; the remaining third served for validation.ResultsOf 344 derivation-set patients and 172 validation-set patients, 96 and 49 had PLTEs, respectively. Items significantly associated with PLTEs were vomiting, sudden onset of pain, and pain to palpation. Sensitivity of the decision tree based on these three features was 87.5% (95% confidence interval (95% CI), 81%-94%) in the derivation set and 83.7% in the validation set. Derivation of the decision tree provided probabilities of PLTE of 13% (95% CI, 6%-19%) in the low-risk group, 27% (95% CI, 20%-33%) in the intermediate-risk group and 62% (95% CI, 48%-76%) in the high-risk group, ruling out PLTE with a specificity of 92.3%; (95% CI, 89%-96%). In the validation dataset, PLTE probabilities were 16.3% in the low-risk group, 30.6% in the intermediate-risk group, and 44% in the high-risk group, ruling out the diagnosis of PLTE with a specificity of 88.6%.ConclusionA simple triage model based on a standardized questionnaire may assist in the early identification of patients with PLTEs among patients seen in the gynecology emergency room for acute pelvic pain.

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Section: Methodsmentioning

confidence: 99%

Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology

et al. 2014

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“…Many women are treated with methotrexate when an ectopic pregnancy is suspected (based on non specific ultrasound findings) when the positive predictive value is only approximately 80%. 18 More problematic is that some women are treated with methotrexate simply when there is no evidence of an intrauterine gestation. It has been repeatedly demonstrated that up to 50% of women with a high hCG value and no evidence of an intrauterine pregnancy on ultrasound have an intrauterine gestation, not an ectopic pregnancy.…”

Section: Risk Of Treatment Of An Intrauterine Pregnancymentioning

confidence: 99%

Medical Management of Ectopic Pregnancy

Bachman¹,

Barnhart²

2012

Clinical Obstetrics &Amp; Gynecology

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Medical management has become increasingly popular in the treatment of ectopic pregnancy. Given its convenience, for many it is used as a first line treatment, but this is not always the optimal choice for the patient. It is important to understand the options for medical treatment and when it is appropriate to treat a particular patient with medical management, or when one should opt for surgical management. This review outlines the different regimens for methotrexate administration and the associated risks and benefits to medical management.

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“…Clinical interpretation of TVS in patients with hCG levels close to, or below the discriminatory zone, is challenging and initial TVS alone cannot detect 26% of EPs (5). Additional factors may impact the diagnostic utility of TVS (8, 9). …”

Section: Introductionmentioning

confidence: 99%

Performance of human chorionic gonadotropin curves in women at risk for ectopic pregnancy: exceptions to the rules

Morse

Sammel

Shaunik

et al. 2012

Fertility and Sterility

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Objective To investigate the accuracy of serial hCG to predict outcome of a pregnancy of unknown location in an ethnically and geographically diverse setting. Design Multi-site cohort study Setting University hospital Patients Women with a pregnancy of unknown location Interventions None Main outcome measures Patients were followed until diagnosed with ectopic pregnancy (EP), intrauterine pregnancy (IUP), or miscarriage. To predict outcome, observed hCG was compared to recommended thresholds to assess deviation from defined normal curves. Predicted outcome was compared to standard of care. Sensitivity, specificity, predictive value, and accuracy were calculated, stratified by diagnosis. Results The final diagnosis 1,005 patients included 179 EPs, 259 IUPs, and 567 miscarriages. The optimal balance in sensitivity and specificity used the minimal expected two-day rise in hCG of 35%, and the minimal two-day decline in hCG of 36–47% (depending on the level) achieving 83.2% sensitivity, 70.8% specificity to predict EP. However 16.8% of EPs and 7.7% of IUPs would be misclassified solely using serial hCGs. Consideration of a third hCG and early ultrasound decreased IUP misclassification to 2.7%. Conclusion Solely using serial hCG values can result in misclassification. Clinical judgment should trump prediction rules and continued surveillance with a third hCG may be prudent, especially when initial values are low or when values are near suggested thresholds.

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Clinical Factors Affecting the Accuracy of Ultrasonography in Symptomatic First-Trimester Pregnancy

Abstract: II.

Cited by 44 publications

References 11 publications

Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology

Triage using a self-assessment questionnaire to detect potentially life-threatening emergencies in gynecology

Medical Management of Ectopic Pregnancy

Performance of human chorionic gonadotropin curves in women at risk for ectopic pregnancy: exceptions to the rules

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