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Emergency department screening for ectopic pregnancy: a prospective US study
B H Braffman1, B G Coleman, P Ramchandani
1Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104.
Purpose:
To determine the effectiveness of pelvic sonography as a screening test for ectopic pregnancy.
Materials And Methods:
Pelvic sonograms were prospectively analyzed in 1,427 consecutive patients with a serum level of the beta subunit of human chorionic gonadotropin of over 1,500 IU/L.
Results:
Sonograms were diagnostic in 1,158 patients and indeterminate in 269. When indeterminate studies were considered falsely negative, the diagnostic accuracy was 81%. Twenty-four percent of patients with indeterminate studies were subsequently proved to have ectopic pregnancy. In ectopic pregnancy (n = 103), the most common finding was a complex adnexal mass (specificity = 92% [P < .001]). The sensitivity and specificity of screening sonography for ectopic pregnancy were 99% and 84%, respectively.
Conclusion:
Pelvic sonography is an effective screening test for ectopic pregnancy. Having a one in four chance of harboring an ectopic pregnancy, patients with indeterminate studies require close follow-up. The presence of a complex adnexal mass is a strong predictor of ectopic pregnancy.