Accuracy of clinical diagnostic methods of threatened abortion.
OBJECTIVE
To examine the accuracy of clinical diagnostic methods in assessing vaginal bleeding in pregnant women before 28 weeks' gestation.


METHODS
772 consecutive women who presented with threatened abortion before 28 weeks' gestation were studied. Structured history and physical examination were performed on each woman as initial clinical assessment. This was followed by transvaginal sonography to determine the status of pregnancy. The accuracy of diagnoses at different clinical stages (history, physical examination, and transvaginal sonography) relative to the final diagnosis was compared using the kappa coefficient (kappa).


RESULTS
Clinicians were unable to accurately diagnose or predict the status of the pregnancy from history alone (kappa = 0.33; 95% CI 0.28, 0.38) or after physical examination (kappa = 0.57; 95% CI 0.52, 0.62). Transvaginal sonography led to an accurate diagnosis of pregnancy status (kappa = 0.96; 95% CI 0.95, 0.98) in most cases, except where an ectopic pregnancy existed. Absence of abdominal tenderness (p = 0.04), cervical excitation (p = 0.02), and incorrect identification of retained products of conception on transvaginal sonography (p = 0.01) were features of missed ectopic pregnancy.


CONCLUSIONS
The clinical assessment of threatened abortion by history and physical examination is unreliable in most cases. The diagnostic accuracy is improved by the addition of transvaginal sonography. Even with the help of transvaginal sonography, a small proportion of ectopic pregnancies will be missed.
Yip
Shing-Kai
SK
Department of Obstetrics and Gynecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, PR China. yipsk@cuhk.edu.hk
Sahota
Daljit
D
Cheung
Lai-Ping
LP
Lam
Peggo
P
Haines
Christopher John
CJ
Chung
Tony Kwok-Hung
TK
D000033:Abortion, Threatened / Q000175:diagnosis*; D005260:Female; D005865:Gestational Age; D006801:Humans; D010808:Physical Examination; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal