Hemoperitoneum assessment in ectopic pregnancy

“…PLTEs were defined as gynecological or nongynecological disorders causing acute pain and associated with a high risk of complications likely to cause residual impairments, severe morbidity, or death within a short period in the absence of appropriate emergency surgical or radiological treatment [3]. This definition included (i) ectopic pregnancy with tubal rupture or active bleeding or fetal cardiac activity or hemoperitoneum exceeding 300 mL [9,18]; (ii) complicated pelvic inflammatory disease with tuboovarian abscess or pelvic peritonitis [8,15,19]; (iii) adnexal torsion [11]; (iv) hemoperitoneum exceeding 300 mL due to rupture of hemorrhagic ovarian cysts or other gynecological causes (uterine rupture in the first trimester of pregnancy, rupture of a pedunculated uterine fibroid, rupture of an arteriovenous malformation, or uterine perforation); (v) appendicitis; and (vi) intestinal obstruction.…”

Section: Methodsmentioning

confidence: 99%

“…Examples of these PLTEs, presenting with acute pelvic pain as a common signal precursor, include ectopic pregnancy [3,6], adnexal torsion [7] or tuboovarian abscess [8] which can lead to hemodynamic instability, organ failures, severe morbidity and death. Triage tools specifically designed for gynecological emergencies may be useful to rapidly identify patients in whom endovaginal ultrasonography by a gynecologist or radiologist may detect a condition requiring prompt treatment, thus protecting the patient from life-threatening or function-threatening events [6,8,9]. …”

Section: Introductionmentioning

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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“…The TVUS findings were determined by blinded observers using objective criteria. These criteria are reliable and have been proven useful for diagnosing specific gynecologic emergencies [9,10,13,15,21]. …”

Section: Discussionmentioning

confidence: 99%

Routine ultrasound examination by OB/GYN residents increase the accuracy of diagnosis for emergency surgery in gynecology

et al. 2013

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IntroductionDiagnostic accuracy of first-line sonographic evaluation by obstetrics/gynecology residents in determining the need for emergency surgery in women with acute pelvic pain is unknown. Aim of this study was to evaluate the diagnostic accuracy of routine ultrasound evaluation by obstetrics/gynecology residents, available 24 hours a day, in patients with acute pelvic pain.MethodsA cross-sectional retrospective study included consecutive patients who underwent emergency laparoscopy for acute pelvic pain at a teaching hospital gynecologic emergency unit, between January 1, 2004, and December 31, 2006. The laparoscopic diagnosis was the reference standard. Gynecologic and nongynecologic conditions requiring immediate surgery to avoid severe morbidity or death were defined as surgical emergencies. In all patients, obstetrics/gynecology residents routinely performed clinical examination and standardized ultrasonography was routinely recorded. Sonograms were re-interpreted for the study, blinded to physical examination and laparoscopic findings, according to evidence-based predetermined criteria. Sensitivity, specificity, and likelihood ratios were computed for clinical data alone, sonographic data alone, and the combination of both.ResultsEmergency laparoscopy was performed in 234 patients, diagnosing 139 (59%) surgical emergencies. Clinical and sonographic examinations performed by the residents each independently predicted a need for emergency surgery. Combining both examinations was superior over each examination alone and had an acceptable false-negative rate of 1%.ConclusionsFirst-line combined clinical and sonographic examination by obstetrics/gynecology residents is effective in ruling out surgical emergencies in patients with acute pelvic pain.

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Hemoperitoneum assessment in ectopic pregnancy

Abstract: Both clinical examination and standardized ultrasonography were found to be useful for accurate evaluation of hemoperitoneum in patients presenting with EP.

Cited by 9 publications

References 23 publications

Adnexal Sonographic Findings in Ectopic Pregnancy and Their Correlation With Tubal Rupture and Human Chorionic Gonadotropin Levels

Adnexal Sonographic Findings in Ectopic Pregnancy and Their Correlation With Tubal Rupture and Human Chorionic Gonadotropin Levels

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

Routine ultrasound examination by OB/GYN residents increase the accuracy of diagnosis for emergency surgery in gynecology

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