MANAGEMENT OF SUSPECTED ECTOPIC PREGNANCY - IMPACT OF NEW DIAGNOSTIC-TOOLS IN 686 CONSECUTIVE CASES

OBJECTIVE: To analyze the impact of new diagnostic tools oil the use o f laparoscopy oil patients with suspected ectopic pregnancy (EP). STUD Y DESIGN: Analysis of 686 consecutive patients who underwent laparosco py or laparotomy for suspected EP from 1983 to 1995 at the Academic Me dical Center, University of Amsterdam, Amsterdam, the Netherlands. RES ULTS: With the introduction of more sensitive urine pregnancy tests, t he positive predictive value (PPV) of diagnostic management increased from 0.42 in 1983 to 0.91 in 1988. The introduction of transvaginal so nography improved this figure to 0.93 in 1989. Move recently, a PPV of 0.95 was achieved by adding serum human chorionic gonadotropin measur ements to the diagnostic workup. The sensitivity and specificity of th is new strategy were 0.97 and 0.96. CONCLUSION: New diagnostic methods greatly re duced the need for laparoscopy to diagnose or rule out EP. The largest impact resulted from the introduction of better pregnancy tests. The effect of other sophisticated tools was less dramatic but eventually contributed to a near perfect noninvasive diagnostic manage ment, thus opening new perspectives for nonoperative treatment modalit ies.