IS THIS PATIENT PREGNANT - CAN YOU RELIABLY RULE IN OR RULE OUT EARLY-PREGNANCY BY CLINICAL EXAMINATION

This review addresses a common problem facing the clinician: ''When tr eating or evaluating a woman of childbearing years, what is the value of historical or physical examination features in determining the prob ability of early pregnancy?'' We focus on the clinical examination fin dings that may help the clinician rule in or rule out early pregnancy. Generally accepted indicators of pregnancy include amenorrhea, mornin g sickness, tender or tingling breasts, and, after 8 weeks' gestationa l age, an enlarged uterus with a soft cervix. We reviewed the value ti e, sensitivity and specificity) of these indicators, as well as home p regnancy test results, as predictors of the diagnosis of early pregnan cy. The available evidence suggests that some historical features, whe n absent, are fair but not reliable for ruling out pregnancy. When dia gnosing early pregnancy, the clinician should not rely on the clinical examination or a home pregnancy test-a laboratory test should be requ ested.