Faculty Collaboration Database

Outcome analysis of a protocol including bedside endovaginal sonography in patients at risk for ectopic pregnancy. Ann Emerg Med 1996 Mar;27(3):283-9

Date

03/01/1996

Pubmed ID

8599484

DOI

10.1016/s0196-0644(96)70260-3

Scopus ID

2-s2.0-0029918552 (requires institutional sign-in at Scopus site)   78 Citations

Abstract

STUDY OBJECTIVES: To determine whether bedside endovaginal sonography (EVS) performed by emergency physicians reduces complications associated with ectopic pregnancy (EP) including missed EP and EP rupture.

METHODS: Our setting was an urban trauma center emergency department. We assembled a prospective convenience sample (n=314) with a historical EP control group (n=56) of women 18 years or older with a positive pregnancy test and any signs, symptoms, or risk factors for EP. Bedside EVS for all subjects and immediate quantitative serum human chorionic gonadotropin determination for patients with no definite intrauterine pregnancy by EVS.

RESULTS: Retrospective chart review identified 56 EP patients in the historical control group who had had no bedside EVS. Twenty-four of these patients (43%; 95% confidence interval [CI], 30% to 56%) were discharged from the ED, 12 of whom (50%; 95% CI, 30% to 70%) were later categorized as having ruptured EP. During the prospective study period, 40 patients were diagnosed as having EP; 11 (28%; 95% CI, 14% to 42%) were discharged from the ED (P=NS), and only 1 (9%; 95% CI, 0% to 26%) of the discharged patients was later determined to have a ruptured EP (P<.05).

CONCLUSION: An EP protocol incorporating bedside EVS performed by emergency physicians significantly reduced the incidence of discharged patients with subsequent EP rupture, compared with historical controls.

Author List

Mateer JR, Valley VT, Aiman EJ, Phelan MB, Thoma ME, Kefer MP

Author

Mary Beth Phelan MD, RDMS Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Clinical Protocols
Emergency Service, Hospital
Female
Humans
Pregnancy
Pregnancy, Ectopic
Prospective Studies
Risk Factors
Rupture
Trauma Centers
Treatment Outcome
Ultrasonography, Prenatal