Use of a checklist to rule out pregnancy: a systematic review

Abstract

Background: Safe initiation of contraceptive methods requires that pregnancy be excluded. The World Health Organization has developed a list of criteria to assess pregnancy status. This review was conducted to evaluate the evidence regarding these criteria in excluding pregnancy.

Study design: The PubMed database was searched from database inception through March 2012 for all peer-reviewed articles in any language concerning the performance of a pregnancy checklist compared to urine pregnancy tests. The quality of each study was assessed using the United States Preventive Services Task Force grading system.

Results: Four analyses of data from three studies met inclusion criteria as direct evidence. All were diagnostic accuracy studies of fair quality that evaluated the performance of a pregnancy checklist compared with urine pregnancy test to rule out pregnancy. The performance of the checklist varied, with sensitivity ranging from 55-100% and specificity ranging from 39-89%. The negative predictive value was consistent across studies at 99-100%.

Conclusion: All four analyses demonstrated high (99-100%) negative predictive value for the pregnancy checklist.