Bwj. Mol et al., Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy?, FERT STERIL, 71(1), 1999, pp. 167-173
Objective: To evaluate the ability of noninvasive diagnostic tools to predi
ct tubal rupture and active bleeding in patients with tubal pregnancy.
Design: Prospective cohort study.
Setting: Two large teaching hospitals in Amsterdam, The Netherlands.
Patient(s): Consecutively seen patients with suspected tubal pregnancy who
were scheduled to undergo confirmative laparoscopy.
Main Outcome Measure(s): Tubal rupture and/or active bleeding confirmed at
laparoscopy.
Result(s): Sixty-five (23%) of 288 patients had tubal rupture and/or active
bleeding at laparoscopy. Abdominal pain, rebound tenderness on abdominal e
xamination, fluid in the pouch of Douglas at transvaginal ultrasound examin
ation, and a low serum hemoglobin level were independent predictors of tuba
l rupture and/or active bleeding. Pregnancy achieved with the use of IVF-ET
and the presence of an ectopic gestational sac or an ectopic mass at ultra
sound examination reduced the risk of tubal rupture. Abdominal pain was the
most sensitive predictor, with a sensitivity of 95%.
Conclusion(s): Because the nonsurgical management of tubal pregnancy should
be used only when the risk of tubal rupture and/or active bleeding is low,
it can be safely applied in only a limited number of patients. (C) 1998 by
American Society for Reproductive Medicine.