Early diagnosis of ectopic pregnancy. Does use of a strict algorithm decrease the incidence of tubal rupture?

To determine if tubal rupture rates are decreased when a strict diagnostic algorithm is employed in the evaluation of women with suspected ectopic pregnancy as compared to individualized diagnostic methods.

Between 1994 and 1996, a group of investigators at Charleston Area Medical Center employed a strict diagnostic algorithm consisting of serum quantitative human chorionic gonadotropin (hCG) levels, progesterone levels, ultrasound and endometrial curettage in order to expedite diagnosis when ectopic pregnancy was suspected (group A patients). Other practitioners employed traditional criteria in similar clinical situations (group B patients). Medical records of patients diagnosed with ectopic pregnancy in this period were retrospectively reviewed. Demographic data, clinical and laboratory characteristics, and rate of tubal rupture were compared.

Sixty-one of 122 patients were diagnosed with ectopic pregnancy by strict criteria. These patients did not differ significantly from those evaluated by an individualized approach in regard to age, gravidity, parity or risk factors for ectopic pregnancy. Menstrual age, hCG levels and progesterone levels were similar as well. Group A patients had a median diagnostic interval of 2 days, with a range of 0-16. Group B patients had a median diagnostic interval of 8 days, with a range of 0-44 (P < .001). Of patients evaluated by this strict algorithm, 3.3% experienced rupture as compared to 23% of patients in group B (P < .001).

Use of a strict diagnostic algorithm in the evaluation of patients with suspected ectopic pregnancy resulted in decreased tubal rupture rates. Such an algorithm could be disseminated to all locations for triage of patients and use in a standardized manner. This practice could result in a reduction in loss of reproductive function and mortality secondary to ectopic pregnancy.