| Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies. | |
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MedLine Citation:
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PMID: 9055772 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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B Durham; B Lane; L Burbridge; S Balasubramaniam |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of emergency medicine Volume: 29 ISSN: 0196-0644 ISO Abbreviation: Ann Emerg Med Publication Date: 1997 Mar |
Date Detail:
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Created Date: 1997-03-28 Completed Date: 1997-03-28 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 338-47 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Martin Luther King-Los Angeles County Medical and Trauma Center, California, USA. brittan@mem.po.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Chorionic Gonadotropin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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