Rodea RH, Athié GC, Guízar BC, Montalvo JE

Language: Spanish
References: 0
Page: 144-147
PDF size: 43.54 Kb.

ABSTRACT

Objective: To describe and assess the diagnostic value of a flowchart for the fast detection of ruptured ectopic pregnancy (REP).
Setting: Third level health care hospital.
Design: Prospective, longitudinal, observational, and descriptive study.
Statistics: Percentages as summary measure for qualitative variables, sensitivity, positive and negative predictive values (PPV and NPV), and diagnostic certainty.
Material and method: During 10 years, a diagnostic flowchart was applied that included association among: Woman in fertile age, pelvic or low abdominal pain, menstruation cycle or abnormal transvaginal bleeding, hemodynamic alterations (tachycardia, hypotension, or shock index › 0.7), and positive immunologic pregnancy test to all women attended due to acute abdomen. The primary endpoint was the diagnostic value of the suggested flowchart. Secondary variables were: age, anticonception methods, main clinical symptoms, site of implantation, blood loss, presence of a state of shock, time between admittance and surgery, and maternal mortality.
Results: From the 7,867 attended patients due to acute abdomen, REP was suspected in 392, of which 352 were confirmed, yielding a sensitivity of 94.8%, specificity of 99.5%, PPV of 89.7%, NPV of 99.7% and diagnostic certainty of 99.2%. Final diagnoses different from REP were: ovarian hemorrhagic cyst in 31 cases (77.5%), non-ruptured EE in 5 (12.5%), syndrome of half the menstrual cycle in 2 (5%), endometriosis in the remainder 2 (5%). Average time between admittance and surgery was 96 minutes (range from 30 to 6000); no mortality was encountered.
Conclusion: The proponed flowchart allows the first contact surgeon to suspect and provide timely treatment in REP cases.