Does This Woman Have an Ectopic Pregnancy?

Crochet, John R.; Bastian, Lori A.; Chireau, Monique

doi:10.1001/jama.2013.3914

Cited by 78 publications

(30 citation statements)

References 69 publications

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“…[50] carried out a systematic review assessing the accuracy and precision of patient history, clinical examination, available laboratory test values, and ultrasonography for the diagnosis of ectopic pregnancy in women with abdominal pain or vaginal bleeding early in pregnancy. They found that all components of patient history had a positive likelihood ratio below 1.5.…”

Section: Discussionmentioning

confidence: 99%

Non-Invasive Tools for the Diagnosis of Potentially Life-Threatening Gynaecological Emergencies: A Systematic Review

et al. 2015

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ObjectiveTo identify non-invasive tools for diagnosis of the major potentially life-threatening gynaecological emergencies (G-PLEs) reported in previous studies, and to assess their diagnostic accuracy.MethodsMEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched to identify all eligible studies published in English or French between January 1990 and December 2012. Studies were considered eligible if they were primary diagnostic studies of any designs, with a gold standard and with sufficient information for construction of a 2 × 2 contingency table, concerning at least one of the following G-PLEs: complicated ectopic pregnancy, complicated pelvic inflammatory disease, adnexal torsion and haemoperitoneum of any gynaecological origin. Extraction of data and assessment of study quality were conducted by two independent reviewers. We set the thresholds for the diagnostic value of signs retrieved at Sensibility ≥ 95% and LR—≤ 0.25, or Specificity ≥ 90% and LR+ ≥ 4.ResultsWe identified 8288 reports of diagnostic studies for the selected G-PLEs, 45 of which met the inclusion criteria. The methodological quality of the included studies was generally low. The most common diagnostic tools evaluated were transvaginal ultrasound (20/45), followed by medical history (18/45), clinical examination (15/45) and laboratory tests (14/45). Standardised questioning about symptoms, systolic blood pressure<110 mmHg, shock index>0.85, identification of a mass by abdominal palpation or vaginal examination, haemoglobin concentration <10 g/dl and six ultrasound and Doppler signs presented high performances for the diagnosis of G-PLEs. Transvaginal ultrasound was the diagnostic tool with the best individual performance for the diagnosis of all G-PLEs.ConclusionThis systematic review suggests that blood pressure measurement, haemoglobin tests and transvaginal ultrasound are cornerstone examinations for the diagnosis of G-PLEs that should be available in all gynaecological emergency care services. Standardised questioning about symptoms could be used for triage of patients.

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Section: Discussionmentioning

confidence: 99%

Non-Invasive Tools for the Diagnosis of Potentially Life-Threatening Gynaecological Emergencies: A Systematic Review

et al. 2015

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“…[3][4][5][6][7] The implementation of point-of-care ultrasound (POCUS), performed by an emergency physician, has already been demonstrated to potentially improve outcome in the pregnant cohort. [8][9][10] Despite this, in many practice environments, specialty-performed ultrasound or radiology department ultrasound (RDUS) is often obtained. As a result of timerelated issues with RDUS, there is an inherent risk of delay in diagnosis and prolongation of ED length of stay (LOS).…”

Section: Introductionmentioning

confidence: 99%

Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay

Se¹,

Connolly²,

Lahham³

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND:The study aimed to compare the time to overall length of stay (LOS) for patients who underwent point-of-care ultrasound (POCUS) versus radiology department ultrasound (RDUS). METHODS:This was a prospective study on a convenience sample of patients who required pelvic ultrasound imaging as part of their emergency department (ED) assessment. RESULTS:We enrolled a total of 194 patients who were on average 32 years-old. Ninety-eight (51%) patients were pregnant (<20 weeks). Time to completion of RDUS was 66 minutes longer than POCUS (95%CI 60-73, P<0.01). Patients randomized to the RDUS arm experienced a 120 minute longer ED length of stay (LOS) (95%CI 66-173, P<0.01) CONCLUSION:In patients who require pelvic ultrasound as part of their diagnostic evaluation, POCUS resulted in a signifi cant decrease in time to ultrasound and ED LOS.

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“…4,5 However, if there is also evidence of an adnexal mass then there is a higher likelihood for being an ectopic pregnancy. 5,6 When an ectopic pregnancy is a consideration, a transabdominal ultrasound should be followed by a transvaginal study to adequately evaluate the adnexa. 2,5 When echogenic material, such as clotted blood, is seen within an anechoic uterine sac, the POCUS evaluation can be challenging and must be differentiated from a true yolk sac and fetal pole.…”

Section: Introductionmentioning

confidence: 99%

Hemorrhagic Contents Within Uterine Sac Mimicking Intrauterine Pregnancy on Point-of-Care Ultrasound: A Case Report of a Ruptured Ectopic Pregnancy

Lindquist¹,

Perera²,

Chao³

et al. 2016

Emerg Med Open J

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CitationLindquist B, Perera P, Chao A, Lobo V, Gharahbaghian L. Hemorrhagic contents within uterine sac mimicking intrauterine pregnancy on point-of-care ultrasound: A case report of a ruptured ectopic pregnancy [Video]. Case ReportPage 11 ABSTRACTWe present a case of a female patient who presented to the emergency department (ED) with lower abdominal pain and was found to have a ruptured ectopic pregnancy with hemorrhagic uterine contents mimicking a fetal pole on bedside transabdominal point-of-care ultrasound (POCUS). The case reinforces the importance of accurately interpreting the transabdominal pelvic POCUS for potential mimics of an intrauterine pregnancy. In addition, the case also emphasizes the performance of an abdominal ultrasound for free fluid assessment in the right and left upper quadrants to evaluate for free fluid in patients with concerns for a ruptured ectopic pregnancy.

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Does This Woman Have an Ectopic Pregnancy?

Cited by 78 publications

References 69 publications

Non-Invasive Tools for the Diagnosis of Potentially Life-Threatening Gynaecological Emergencies: A Systematic Review

Non-Invasive Tools for the Diagnosis of Potentially Life-Threatening Gynaecological Emergencies: A Systematic Review

Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay

Hemorrhagic Contents Within Uterine Sac Mimicking Intrauterine Pregnancy on Point-of-Care Ultrasound: A Case Report of a Ruptured Ectopic Pregnancy

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