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Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy?
B W Mol1, P J Hajenius, S Engelsbel
1Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, The Netherlands. b.w.mol@amc.uva.nl
Objective:
To evaluate the ability of noninvasive diagnostic tools to predict tubal rupture and active bleeding in patients with tubal pregnancy.
Design:
Prospective cohort study.
Setting:
Two large teaching hospitals in Amsterdam, The Netherlands.
Patient(S):
Consecutively seen patients with suspected tubal pregnancy who were scheduled to undergo confirmative laparoscopy.
Main Outcome Measure(S):
Tubal rupture and/or active bleeding confirmed at laparoscopy.
Result(S):
Sixty-five (23%) of 288 patients had tubal rupture and/or active bleeding at laparoscopy. Abdominal pain, rebound tenderness on abdominal examination, fluid in the pouch of Douglas at transvaginal ultrasound examination, and a low serum hemoglobin level were independent predictors of tubal rupture and/or active bleeding. Pregnancy achieved with the use of IVF-ET and the presence of an ectopic gestational sac or an ectopic mass at ultrasound examination reduced the risk of tubal rupture. Abdominal pain was the most sensitive predictor, with a sensitivity of 95%.
Conclusion(S):
Because the nonsurgical management of tubal pregnancy should be used only when the risk of tubal rupture and/or active bleeding is low, it can be safely applied in only a limited number of patients.