SCREENING FOR ECTOPIC PREGNANCY IN SYMPTOM-FREE WOMEN AT INCREASED RISK

Objective: To determine the ectopic pregnancy rate among symptom-free women at increased risk undergoing a screening program involving trans vaginal sonography and serum hCG testing. Methods: Consecutive symptom -free women at increased risk for ectopic pregnancy were studied prosp ectively by transvaginal sonography and serum hCG measurement to detec t ectopic pregnancy before the onset of symptoms. Results: Between Sep tember 1993 and May 1996, 143 symptom-free pregnant women with pregnan cies of a gestational age of less than 7 weeks were screened. Eight ha d ectopic pregnancies, 129 had intrauterine pregnancies, and six had t rophoblast in regression. Among the eight women with ectopic pregnanci es, one was initially diagnosed as having an intrauterine pregnancy. T his woman returned 1 week later with abdominal pain, and an ectopic pr egnancy with intra-abdominal bleeding was found. Ectopic pregnancies w ere present in 5.6% (95% confidence interval 2.5%, 10.7%) of the women screened. This was significantly lower than reported in a previous st udy. Conclusion: The ectopic pregnancy rate in the population that was offered screening was low. Thus, it is questionable whether the possi ble benefits (prevention of complications and reassurance of the woman ) outweigh possible detriments (false-positive diagnosis, financial co sts, and emotional stress that could be induced by screening). (C) 199 7 by The American College of Obstetricians and Gynecologists.