FAILURE OF STANDARD CRITERIA TO DIAGNOSE NONEMERGENCY ECTOPIC PREGNANCIES IN A NONINFERTILITY PATIENT POPULATION

Algorithms for the diagnosis of ectopic pregnancy are applied independ ent of the patient population. However, patients may require care at v arious times of gestation or for different reasons. To examine the uti lity of the same diagnostic criteria for identifying an ectopic pregna ncy in different patient populations, we evaluated women from the infe rtility clinic and the residents' gynecology clinic at Yale-New Haven Hospital. Sixty women with nonemergency ectopic pregnancies were ident ified 38 from the infertility clinic and 22 from the residents' clinic . Although the most common symptoms were the same in both groups (abdo minal pain, spotting/bleeding >3 days, dizziness, shoulder pain), they were significantly more frequent in women from the residents' clinic. Despite care by the same attending physicians, ruptured ectopic pregn ancies were more than 3 times as likely to occur in the noninfertility patients, and half as likely to be treated laparoscopically (p<0.01). Patients from the residents' clinic also were more likely to ha ve po stoperative complications(p<0.05), and had over a threefold higher ris k of receiving a blood transfusion. We conclude that criteria for diag nosis and intervention in ectopic pregnancy may have to be modified on the basis of characteristics of the patient population.