title: Emergency department screening for ectopic pregnancy: a prospective US study.
abstract: OBJECTIVE
  To determine the effectiveness of pelvic sonography as a screening test for ectopic pregnancy.
  
  
  METHODS
  Pelvic sonograms were prospectively analyzed in 1,427 consecutive patients with a serum level of the beta subunit of human chorionic gonadotropin of over 1,500 IU/L.
  
  
  RESULTS
  Sonograms were diagnostic in 1,158 patients and indeterminate in 269. When indeterminate studies were considered falsely negative, the diagnostic accuracy was 81%. Twenty-four percent of patients with indeterminate studies were subsequently proved to have ectopic pregnancy. In ectopic pregnancy (n = 103), the most common finding was a complex adnexal mass (specificity = 92% [P < .001]). The sensitivity and specificity of screening sonography for ectopic pregnancy were 99% and 84%, respectively.
  
  
  CONCLUSIONS
  Pelvic sonography is an effective screening test for ectopic pregnancy. Having a one in four chance of harboring an ectopic pregnancy, patients with indeterminate studies require close follow-up. The presence of a complex adnexal mass is a strong predictor of ectopic pregnancy.
authors.affiliation: Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104.
authors.forename: B H
authors.initials: BH
authors.lastname: Braffman
authors.forename: B G
authors.initials: BG
authors.lastname: Coleman
authors.forename: P
authors.initials: P
authors.lastname: Ramchandani
authors.forename: P H
authors.initials: PH
authors.lastname: Arger
authors.forename: C F
authors.initials: CF
authors.lastname: Nodine
authors.forename: B J
authors.initials: BJ
authors.lastname: Dinsmore
authors.forename: A
authors.initials: A
authors.lastname: Louie
authors.forename: S E
authors.initials: SE
authors.lastname: Betsch
mesh_terms: D000328:Adult; D006063:Chorionic Gonadotropin / Q000097:blood; D018997:Chorionic Gonadotropin, beta Subunit, Human; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D010388:Pelvis / Q000000981:diagnostic imaging; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods; D016216:Ultrasonography, Prenatal
chemical_list: D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments