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

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.