ECTOPIC PREGNANCY - PROSPECTIVE-STUDY WITH IMPROVED DIAGNOSTIC-ACCURACY

Study objective: To assess the utility of ultrasonography, quantitativ e serum beta-human chorionic gonadotropin (beta-hCG) level, history, a nd physical examination in the diagnosis of ectopic pregnancy (EP) in the emergency department. Methods: We prospectively studied 481 consec utive pregnant patients who presented to an urban ED with first-trimes ter abdominal pain or vaginal bleeding. History, physical examination findings, quantitative beta-hCG values, sonography findings, surgical findings, and final diagnosis were collected after patient enrollment in the study. We assessed the proportions of pregnant patients experie ncing pain or bleeding with EPs versus those with abnormal and normal intrauterine pregnancies (IUPs). Results: Pregnant women with abdomina l pain or vaginal bleeding received beta-hCG values; positive radioimm unoassays prompted ultrasonography; indeterminate ultrasonography find ings resulted in admission. Thirteen percent of patients had confirmed EPs; 99.5% of patients discharged from the ED had documented IUPs. Tr ansvaginal sonography in the ED established EP or IUP in 75%. For EP d etection, sonography is 69% sensitive and 99% specific. Single beta-hC G levels are useful in predicting EP; a beta-hCG value of 1,000 mlU/ml or lower shows a fourfold higher risk of EP. History and physical exa mination do not reliably diagnose or rule out EP; of EP patients, 9% r eported no pain and 36% lacked adnexal tenderness. Conclusion: To prev ent delayed diagnosis of EP in urban centers,pregnant women with abdom inal pain or vaginal bleeding require evaluation by transvaginal ultra sonography. indeterminate ultrasonography findings necessitate further evaluation. A beta-hCG level of 1,000 mlU/ml or lower should heighten suspicion of EP.