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How to cope with pregnancy of unknown location: construction of a scoring system

Marjan Haji Heshmati, Maliheh Arab, Robabeh Ghodsi-Ghassemabadi


Background: Women presenting with abdominal pain in their first trimester of pregnancy ‎could have EP, abortion or normal intrauterine pregnancy. The decision about PUL (Pregnancy ‎of unknown Location) is often difficult because of serious medical complications or the moral ‎consequences of misdiagnosis. ‎Objective: Construct a scoring system to triage EP among PUL patients in pregnant women ‎with abdominal pain. ‎Method: Medical history, symptoms and signs, laboratory data, and sonography of 522 ‎pregnant women presented with abdominal pain in their first trimester at Imam Hossein ‎Medical Center in Tehran were recorded through a questionnaire. Patients were compared in EP ‎and non-EP groups (abortion and normal pregnancy). Based on the univariate analysis, ‎statistically significant variables were used in the construction of a logistic regression model, ‎and finally a clinical scoring system was developed. ‎Results: In this cross-sectional study, medical record of 522 cases including 183 (36%) EP and ‎‎334 (64%) Non-Ep patients were reviewed. Among 92 studied variables, 41 items were ‎significantly correlated with EP diagnosis (P-Value <0.05). Six variables (duration of pain ‎before hospitalization less than 9 hours, gestational age less than 65 days, leukocyte over 8600 ‎‎/ml, abdominal tenderness (superficial, deep or generalized), abdominal or pelvic free fluid, ‎and pain (intermittent, persistent, obscure, shifting, and radiating)), were identified as ‎predictors of EP detection in the logistic regression model and scoring system. Based on the ‎proposed scoring system, patients with scores 0 to 4 were considered as low‏-‏risk (5% ‎probability), scores 5-8 as moderate-risk (63% probability), and scores 9 to 14 were considered ‎as high-risk (95% probability) for EP.‎Conclusions: The present scoring system could help clinicians to find EP among PUL patients. ‎In a score of more than 9 (95% probability), interventions (laparoscopy or methotrexate) might ‎be considered‎‎.

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