Document Detail


Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies.
MedLine Citation:
PMID:  9055772     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To determine the accuracy and application of pelvic ultrasound performed by emergency physicians in detecting ectopic pregnancy (EP) in complicated first-trimester pregnancies. METHODS: We studied consecutive pelvic ultrasounds performed in all women who presented with abdominal pain or vaginal bleeding during the first trimester of pregnancy over a 6-month period. Patients with clinical evidence of incomplete abortion were not included. We compared ultrasound results with subsequent ultrasound findings by the radiology department and correlated them with follow-up diagnoses and outcomes. RESULTS: Of the 136 eligible patients, a final diagnosis was rendered in 125; 11 were lost to follow-up. These ED ultrasound findings were recorded: established intrauterine pregnancy (IUP) with embryonic structures, 87 (70%); indeterminate scan revealing no distinct evidence of IUP or EP, 15 (12%); early intrauterine gestational sac of less than 6 weeks without embryonic structures, 12 (10%); EP, 8 (6%); blighted ovum, 2 (2%); and molar pregnancy, 1 (1%). The initial ED ultrasound determination was consistent with radiology department findings, final outcome, or both in 121 (96%) (95% confidence interval [CI], 91% to 97%). ED ultrasound accurately identified 87 pregnancies with intrauterine embryonic structures, including 5 patients with fetal demise (95% Cl, 97% to 100%). Diagnosis of pregnancy location in these 87 patients effectively ruled out EP, with a negative predictive value of 100%. The sensitivity and specificity of ED ultrasound in the detection of EP were 90% and 88%, respectively. CONCLUSION: Pelvic ultrasonography performed by emergency physicians can be used to rule out EP and make an accurate diagnosis in most patients with complicated first-trimester pregnancies during the initial ED visit. The remaining patients at risk can be identified and a diagnosis made by means of follow-up ultrasound and serial hCG determinations.
Authors:
B Durham; B Lane; L Burbridge; S Balasubramaniam
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  29     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-03-28     Completed Date:  1997-03-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  338-47     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency Medicine, Martin Luther King-Los Angeles County Medical and Trauma Center, California, USA. brittan@mem.po.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / blood
Confidence Intervals
Female
Fetal Death / ultrasonography
Gestational Age
Humans
Predictive Value of Tests
Pregnancy
Pregnancy Complications / ultrasonography*
Pregnancy Trimester, First
Pregnancy, Ectopic / ultrasonography*
Prospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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