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VNA of Care New England

Review Looks at Best Modality for Diagnosing Ectopic Pregnancy

Sonogram found to be best diagnostic method for women with abdominal pain, vaginal bleeding
WEDNESDAY, April 24 (HealthDay News) -- For pregnant women with abdominal pain or vaginal bleeding, transvaginal sonography is the best modality for diagnosing ectopic pregnancy, according to research published in the April 24 issue of the Journal of the American Medical Association.
John R. Crochet, M.D., from the Center of Reproductive Medicine in Webster, Texas, and colleagues conducted a systematic review and meta-analysis of prospective studies involving pregnant women with abdominal pain or vaginal bleeding. Using 14 studies involving 12,101 women, they evaluated the accuracy and precision of patient history, clinical evaluation, readily available laboratory values, and sonography, compared with a reference standard, in the diagnosis of ectopic pregnancy.
The researchers found that the likelihood of ectopic pregnancy was increased with the presence of an adnexal mass in the absence of an intrauterine pregnancy on transvaginal sonography and with findings of cervical motion tenderness, an adnexal mass, or adnexal tenderness on physical examination. The likelihood of ectopic pregnancy was decreased with a lack of adnexal abnormalities on transvaginal sonography. Based on existing studies, a single serum human chorionic gonadotropin (hCG) level has not been established that is diagnostic of ectopic pregnancy.
"Transvaginal sonography is the single best diagnostic modality for evaluating women with suspected ectopic pregnancy," the authors write. "The presence of abdominal pain or vaginal bleeding during early pregnancy should prompt a transvaginal sonogram and quantitative serum hCG testing."
Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1681418#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1681418 )
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