Emergency department screening for ectopic pregnancy: a prospective US study.
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.
Braffman
B H
BH
Department of Radiology, University of Pennsylvania Medical Center, Philadelphia 19104.
Coleman
B G
BG
Ramchandani
P
P
Arger
P H
PH
Nodine
C F
CF
Dinsmore
B J
BJ
Louie
A
A
Betsch
S E
SE
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
D006063:Chorionic Gonadotropin; D018997:Chorionic Gonadotropin, beta Subunit, Human; D010446:Peptide Fragments