The value of medical history taking as risk indicator for tuboperitoneal pathology: a systematic review.
BACKGROUND
Guidelines recommend diagnostic laparoscopy in subfertile women with known co-morbidities in their medical history. Aggregated evidence underpinning these recommendations is, however, currently lacking.


OBJECTIVE
The objective of this study was to perform a systematic review and meta-analysis of the available evidence on the association between items reported during medical history taking and tuboperitoneal pathology.


METHODS
MEDLINE (from 1966 to May 2007), EMBASE (from 1960 to January 2007) and bibliographies of retrieved primary articles.


METHODS
All relevant studies that compared medical history with the presence or absence of tubal pathology.


METHODS
Studies comparing medical history with the presence or absence of tubal pathology were included. A diagnosis of tubal pathology had to be made by hysterosalpingography, laparoscopy or a combination of both. In the absence of invasive tubal testing, tuboperitoneal pathology was considered to be absent in case of intrauterine pregnancy. Homogeneity between studies was assessed, and the association between medical history and tubal pathology was expressed as a common odds ratio with a 95% CI. No language restriction was applied.


RESULTS
We included 32 studies. In cohort studies, strong associations were found for a history of complicated appendicitis (OR 7.2, 95% CI 2.2-22.8), pelvic surgery (OR 3.6, 95% CI 1.4-9.0) and pelvic inflammatory disease (PID) (OR 3.2, 95% CI 1.6-6.6), and in case-control studies, for a history of complicated appendicitis (OR 3.3, 95% CI 1.8-6.3), PID (OR 5.5, 95% CI 2.7-11.0), ectopic pregnancy (OR 16.0, 95% CI 12.5-20.4), endometriosis (OR 5.9, 95% CI 3.2-10.8) and sexually transmitted disease (OR 11.9, 95% CI 4.3-33.3).


CONCLUSIONS
Subfertile women reporting a history of PID, complicated appendicitis, pelvic surgery, ectopic pregnancy and endometriosis are at increased risk of having tuboperitoneal pathology. In these women, diagnostic laparoscopy should be offered early in the fertility work-up.
Luttjeboer
F Y
FY
Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands.
Verhoeve
H R
HR
van Dessel
H J
HJ
van der Veen
F
F
Mol
B W J
BW
Coppus
S F P J
SF
D000328:Adult; D015331:Cohort Studies; D005184:Fallopian Tube Diseases / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D008487:Medical History Taking; D016017:Odds Ratio; D000292:Pelvic Inflammatory Disease / Q000150:complications* / Q000175:diagnosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000150:complications* / Q000175:diagnosis