Ectopic pregnancy

The Rational Clinical Examination Series reviewed 14 original studies about diagnosing ectopic pregnancy and yielded the results in the Table.

For interpreting likelihood ratios, consult McGee (PMID: 12213147; PMC1495095); only transvaginal ultrasonography yields helpful accuracy. As frequently happens, the physical examination was much more specific than sensitive.

Sensitivity
(%)
Specificity
(%)
LR+ LR-
cervical motion tenderness 45 91 4.9 0.62
peritoneal findings* 23 to 27 94 to 95 4.2 to 4.5 0.78 to 0.81
adnexal mass 9 96 2.4 0.94
adnexal tenderness 61 65 1.9 0.57
transvaginal ultrasonography 88 99 111 0.12
* Only two studies. Did not pool

Reference

Crochet JR, Bastian LA, & Chireau MV (2013). Does this woman have an ectopic pregnancy?: the rational clinical examination systematic review. JAMA : the journal of the American Medical Association, 309 (16), 1722-9 PMID: 23613077

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