Can noninvasive diagnostic tools predict tubal rupture or active bleeding in patients with tubal pregnancy?

Fertil Steril. 1999 Jan;71(1):167-73. doi: 10.1016/s0015-0282(98)00418-x.


Objective: To evaluate the ability of noninvasive diagnostic tools to predict tubal rupture and active bleeding in patients with tubal pregnancy.

Design: Prospective cohort study.

Setting: Two large teaching hospitals in Amsterdam, The Netherlands.

Patient(s): Consecutively seen patients with suspected tubal pregnancy who were scheduled to undergo confirmative laparoscopy.

Main outcome measure(s): Tubal rupture and/or active bleeding confirmed at laparoscopy.

Result(s): Sixty-five (23%) of 288 patients had tubal rupture and/or active bleeding at laparoscopy. Abdominal pain, rebound tenderness on abdominal examination, fluid in the pouch of Douglas at transvaginal ultrasound examination, and a low serum hemoglobin level were independent predictors of tubal rupture and/or active bleeding. Pregnancy achieved with the use of IVF-ET and the presence of an ectopic gestational sac or an ectopic mass at ultrasound examination reduced the risk of tubal rupture. Abdominal pain was the most sensitive predictor, with a sensitivity of 95%.

Conclusion(s): Because the nonsurgical management of tubal pregnancy should be used only when the risk of tubal rupture and/or active bleeding is low, it can be safely applied in only a limited number of patients.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Adult
  • Female
  • Hemoglobinometry
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / etiology
  • Humans
  • Laparoscopy
  • Pain / diagnosis
  • Physical Examination
  • Predictive Value of Tests
  • Pregnancy
  • Pregnancy, Tubal / complications
  • Pregnancy, Tubal / diagnosis*
  • Pregnancy, Tubal / diagnostic imaging
  • Prospective Studies
  • Rupture, Spontaneous
  • Ultrasonography