Rg. Dart et al., Predictive value of history and physical examination in patients with suspected ectopic pregnancy, ANN EMERG M, 33(3), 1999, pp. 283-290
Study objective: To identify historical and physical examination findings t
hat are predictive of ectopic pregnancy (EP) in pregnant patients with abdo
minal pain or bleeding.
Methods: This study was conducted in an urban academic emergency department
as a prospective observational study of consecutive patients from August 1
, 1991, to August 31, 1992, who had abdominal pain or vaginal bleeding and
a positive beta-human chorionic gonadotropin level. Patients were excluded
if they had a diagnostic ultrasound during a previous visit, or if the uter
ine size was larger than 12 weeks by pelvic examination. Data were analyzed
using chi(2) With a P value less than .05 identified as significant. Odds
ratios were determined for significant variables. A classification and regr
ession tree analysis was then performed using the predictive variables to d
erive a decision tree.
Results: Four hundred forty-one patients were enrolled, 57 of whom (13%) ha
d an EP. Factors by history that increased the risk of EP included pain tha
t was described as moderate to severe, lateral, or sharp. Pain located in t
he midline decreased the risk of EP A history of previous intrauterine devi
ce use, infertility, prior pelvic surgery, or tubal ligation were each foun
d to be predictive. On physical examination, the presence of peritoneal sig
ns, cervical motion tenderness, or lateral or bilateral abdominal or pelvic
tenderness increased the risk of EP. A uterine size larger than 8 weeks by
pelvic examination decreased the risk of EP Combinations of predictive var
iables identified subsets of patients with either an increased or decreased
frequency of EP but in no case was a combination identified that would con
firm or exclude this diagnosis with a high degree of certainty.
Conclusion: History and physical examination findings predictive of EP were
identified. However no constellation of findings could confirm or exclude
this diagnosis with a high degree of reliability.