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