Document Detail

Symptom-free women at increased risk of ectopic pregnancy: should we screen?
MedLine Citation:
PMID:  12190842     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Transvaginal sonography, serum human chorionic gonadotrophin (hCG) measurement, and serum progesterone measurement provide the possibility to screen symptom-free women at increased risk of ectopic pregnancy. The objective of the present study was to evaluate the cost-effectiveness of screening for ectopic pregnancy, by addressing the expected benefits and costs of screening for ectopic pregnancy. METHODS: Screening programs incorporating transvaginal sonography, serum hCG measurement, and serum progesterone measurement were compared with a 'watchful waiting' strategy. Data were extracted from the literature. The strategies were compared on the expected number of prevented tubal ruptures, the expected number of false-positive diagnoses, and expected costs. RESULTS: The cost-effectiveness of screening appeared to be strongly dependent on the prevalence of ectopic pregnancy. At a prevalence of ectopic pregnancy of 6%, a screening program with transvaginal sonography and serum hCG measurement would reduce the number of patients with ruptured ectopic pregnancy from 2.1 to 0.61 per 100 screened women. Screening was expected to cost approximately Euro 933 per prevented tubal rupture, whereas the number of expected false-positive diagnoses was 0.64 per prevented tubal rupture. CONCLUSION: We conclude that screening for ectopic pregnancy reduces the number of patients with tubal rupture, but only at the expense of a large false-positive rate. Although sonography in symptom-free women at risk of ectopic pregnancy might be justified for psychological reasons, the medical and economic benefits of such a policy seem to be limited.
Ben W J Mol; Fulco van der Veen; Patrick M M Bossuyt
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Acta obstetricia et gynecologica Scandinavica     Volume:  81     ISSN:  0001-6349     ISO Abbreviation:  Acta Obstet Gynecol Scand     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-08-22     Completed Date:  2002-09-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370343     Medline TA:  Acta Obstet Gynecol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  661-72     Citation Subset:  IM    
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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MeSH Terms
Chorionic Gonadotropin / blood
Cost-Benefit Analysis
Decision Trees
Fallopian Tubes / pathology
False Positive Reactions
Mass Screening / economics,  methods
Pregnancy, Ectopic / diagnosis*,  economics
Progesterone / blood
Risk Factors
Sensitivity and Specificity
Ultrasonography, Prenatal
Reg. No./Substance:
0/Chorionic Gonadotropin; 57-83-0/Progesterone

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