Objective
Assess a scoring system to triage women with a pregnancy of unknown location.
Design
Validation of prediction rule.
Setting
Multicenter study.
Patients
Women with a pregnancy of unknown location.
Main Outcome Measures
Scores were assigned to factors identified at clinical presentation. Total score was calculated to assess risk of ectopic pregnancy women with a pregnancy of unknown location, and a 3-tiered clinical action plan proposed. Recommendations were: low risk, intermediate risk and high risk. Recommendation based on model score was compared to clinical diagnosis.
Interventions
None
Results
The cohort of 1400 women (284 ectopic pregnancy (EP), 759 miscarriages, and 357 intrauterine pregnancy (IUP)) was more diverse than the original cohort used to develop the decision rule. A total of 29.4% IUPs were identified for less frequent follow up and 18.4% nonviable gestations were identified for more frequent follow up (to rule out an ectopic pregnancy) compared to intermediate risk (i.e. monitor in current standard fashion). For decision of possible less frequent monitor, specificity was 90.8% (89.0 – 92.6) with negative predictive value of 79.0% (76.7 – 81.3). For decision of more intense follow up specificity was 95.0% (92.7 – 97.2). Test characteristics using the scoring system replicated in the diverse validation cohort.
Conclusion
A scoring system based on symptoms at presentation has value to stratify risk and influence the intensity of outpatient surveillance for women with pregnancy of unknown location but does not serve as a diagnostic tool.
INTRODUCTION:
The 2012 consensus cervical cancer screening guidelines recommend longer intervals between Papanicolaou (Pap) tests. We evaluated the knowledge and attitudes of women regarding the purpose and frequency of Pap test screening.
METHODS:
A 13-question survey was available to patients 18 years and older presenting to three clinical sites for obstetrical or gynecological care. Survey topics included familiarity with the 2012 consensus screening guidelines, cervical cancer knowledge, and attitudes towards screening.
RESULTS:
Updated data from 752 patients was included for analysis. Participants were primarily age 20-29 (45%) or 30-39 (33%), African American (53%), and had completed at least a high school degree or equivalent (87%). Pap tests were correctly identified as a screening test for cervical cancer by 75% of participants and 72% named Human Papillomavirus as the cause of cervical cancer. However, only 9% of women selected the correct screening intervals for patients age 21-29 and only 3% selected the appropriate screening interval for patients age 30 and above. Overall, 52% were uncomfortable with lengthening screening intervals and 60% would prefer a yearly pap test. However, 62% of women believed that additional education would increase their comfort with less frequent screening.
CONCLUSION:
Across diverse clinical populations, women are knowledgeable about the purpose of Pap tests and about cervical cancer. However, consistent with our previous data analysis, most women are unaware of the updated screening guidelines and many feel uncomfortable with increased screening intervals. Further education regarding the timing of pap tests is necessary to improve women’s comfort with the consensus guidelines.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.