Prediction of Location of a Symptomatic Early Gestation Based Solely on Clinical Presentation

Abstract

Precis-Prediction of location of a symptomatic first-trimester pregnancy based on clinical symptoms and risk factors is possible, but must be used in conjunction with outpatient surveillance.Objective-To evaluate three strategies for diagnosis of women at risk for ectopic pregnancy based on information collected at initial presentation.Methods-Strength of association for risk factors, signs and symptoms obtained at initial presentation of women with pain, bleeding, or both in a first trimester pregnancy and a non-diagnostic ultrasound were calculated using a cohort of 2,026 women. Three models (logistic regression, a numeric scoring system and a Classification and Regression Tree) were created to predict final outcome and tested on a second cohort of 1,634 women. Accuracy was assessed using 2-by-2 tables evaluating the decision of send home vs. do not send home (combination of monitor or intervene) and intervene vs. do not intervene (monitor or send home). Sensitivity, specificity, and predictive values were calculated.Results-The ultimate diagnosis of women in the test population was 304 (18.6%) patients with an ectopic pregnancy, 834 (51.0%) with miscarriage and 494 (30.2%) with an ongoing intrauterine pregnancy. A total of 95.9% of patients with ectopic pregnancy or miscarriage were correctly assigned to the strategy to monitor or intervene upon based on the scoring system, and 97.6% based on the Classification and Regression Tree. The specificity of the decision to send a patient home with a likely intrauterine pregnancy was greater than 95% for all three methods. The sensitivity of all strategies in the decision to intervene for an ectopic pregnancy was greater than 98%.Conclusion-A simplified scoring system based on five factors (age, ectopic history, bleeding, prior miscarriage, and hCG level) was as effective as a Classification and Regression Tree or logistic regression modes in predicting outcome of women at risk for ectopic pregnancy. Prediction of location of a symptomatic first-trimester pregnancy based on clinical symptoms and risk factors is possible, but must be used in conjunction with outpatient surveillance.

Early Initiation of Antenatal Care and Factors Associated with Early Antenatal Care Initiation at Health Facilities in Southern Ethiopia

“…The timing of first booking ranged from first month after last menstrual period to ninth month of gestation. The proportion of women who came for their first ANC within recommended time is lower than studies done in Gondar, Addis Ababa, and higher than studies conducted in Hadiya, Kembata zone, Yem special district, and EDHS 2011 [4,13,[18][19][20][21]. Possible explanation for this might be those who have more proportion of early ANC due to better access and awareness regarding services while the lower proportion may be due to time variation in this study and the access and awareness improvement.…”

“…This finding was supported by and higher than other findings of many studies conducted in different parts of our country [4,14,18,20].…”

“…According to the result, mothers of age ≤ 25 years were found to be more likely to have early initiation of ANC when compared with others (COR = 1.309 95% CI 0.92, 2.458), but not significant. This idea was slightly supported by study done in Addis Ababa, Yem, Gondar, and Debrebrhan; this idea contradicts the study done in Tanzania (18)(19)(20)(21)8). This might be because younger mothers were more informed and convincible to seek appropriate prenatal care.…”

“…The standard of care when evaluating a woman with a potentially complicated firsttrimester pregnancy is to take a detailed history of the risk factors and ascertain the clinical course [18]. Educational status of the women and family income were independent factors for late initiation of ANC [19].…”

Following declining human chorionic gonadotropin values in pregnancies of unknown location: when is it safe to stop?

“…Clinical history, serum quantitative hCG measurement and transvaginal sonography (TVS) are the basic tools for the evaluation of symptomatic early pregnancies (4–6); however, definitive diagnosis may be challenging in some cases (4, 5). Twenty-five to 50% of women with EP initially receive the diagnosis of pregnancy of unknown location (PUL) (7, 8), a term used when no evidence of either an EP or intrauterine pregnancy (IUP) on TVS is recognized (9).…”