Ectopic Pregnancy Clinical Prediction
Info
First trimester? Yes No
Hemodynamically stable? Yes No
Abdominal pain or vaginal bleeding? Yes No
Clinical findings of peritoneal irritation on abdominal exam? Yes No
Definite Cervical Motion Tenderness? Yes No
~Stage 2
Fetal heart tones heard by handheld Doppler? Yes No -
Tissue visible at the cervical os? Yes No -
Pain present (other than midline suprapubic cramping)? Yes No -
Tenderness (any cervical motion tenderness, uterine or adnexal tenderness)? Yes No -
R e s u l t s
~Stage 2
 
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Output
 
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Info
Ectopic Pregnancy Clinical Prediction

This clinical prediction model for ectopic pregnancy requires that the patient be:

  • Hemodynamically stable
  • First trimester of pregnancy
  • Have vaginal bleeding and/or abdominal pain

There are 2 stages to this prediction model, in the first stage, the patient is classified as "High Risk" if they have either or the following:

  • Any signs of peritoneal irritation on abdominal exam
  • Definite cervical motion tenderness

In patients who do not have the high risk items above, additional factors are considered. To be classified as "Intermediate Risk", all of the following must be present:

  • No fetal heart tones by handheld Doppler
  • No tissue visible at the cervical os
  • The presence of pain (other than midline suprapubic cramping) OR tenderness (any cervical motion, uterine or adnexal tenderness)

Patients who do not meet all of these criteria for Intermediate Risk are classified as "Low Risk."

No prediction model is perfect; however, this model allows for risk stratification and classified <1% of cases as being low risk that actually had ectopic pregnancy.

Reference:
Buckley RG, King KJ, Disney JD, et al. History and physical examination to estimate the risk of ectopic pregnancy: validation of a clinical prediction model. Ann Emerg Med. 1999;34(5):589-94.