Is a Self-Assessed Questionnaire Useful for the Diagnosis of Ectopic Pregnancy in Hospitalized Patients?

BACKGROUND

Delayed diagnosis of ectopic pregnancy (EP) is responsible for maternal morbidity and mortality. Our objective was to develop and validate decision rules for the diagnosis of EP, in patients in their first trimester of pregnancy with symptoms, based solely on a self-assessment questionnaire.

METHODS

From September 2006 to March 2008, 574 patients, who have consulted for acute pelvic pain at the gynecologic emergency department (ED) of five hospitals, completed a Self-Assessment Questionnaire for Gynecological Emergencies (SAQ-GE). We included for our study only women in their first trimester of pregnancy experiencing acute pelvic pain and/or vaginal bleeding who were hospitalized (262 patients). Two-thirds of patients were selected to derive the SAQ-GE EP score which was built on multiple logistic regression. One third of patients were used for internal validation.

RESULTS

Five variables were independently and significantly (p<0.05) associated with EP: no frequent need to change sanitary towels (aDOR = 6.1; 95% CI [2.1-17.8]), duration of bleeding > 24 hours (aDOR = 4,3; 95% CI [1,7-11,0]), pain during coughing (aDOR = 3.1; CI 95% [1,4-6,7]), brown discharge (aDOR = 3.0; 95% CI [1.3-7.1]) and unilateral pelvic pain (aDOR = 2.7; 95% CI [1.3-5.9]). The SAQ-GE ectopic pregnancy score was based on these five criteria with values ranging from 0 to 100. The low-risk group of EP (score<25) had a sensitivity of 95.9% 95% CI [89.8-98,9] and an LR- of 0.2 95% CI [0.1-0.5]. The high-risk group (score>70) had a specificity of 97.4 95% CI [90.9-99.7] and a LR+ of 12.3 95% CI [3.0-49.8]. The percentages of EP observed in the validation sample were: 0% in the low-risk group and 88.9% in the high-risk group.

DISCUSSION: These prediction rules that classify patients in a low-risk or high-risk group may prove useful for triaging pregnant women in their first trimester with symptoms before complementary exams.