Contents lists available at SciVerse ScienceDirect
International Journal of Gynecology and Obstetrics
journal homepage: www.elsevier.com/locate/ijgo
Hemoperitoneum assessment in ectopic pregnancy
Thomas Popowski a, b, c,⁎, Cyrille Huchon a, b, c, Flavy Toret-Labeeuw a, Anne A. Chantry c, PhilippeAegerter d, e, Arnaud Fauconnier a, b, c
Department of Gynecology and Obstetrics, Poissy Saint Germain en Laye Hospital, Poissy, France University of Versailles-Saint Quentin en Yvelines, Versailles, France INSERM, Epidemiological Research Unit on Perinatal Health and Women's and Children's Health, Cochin Hospital, Paris, France d Department of Public Health, Ambroise Paré Hospital, Boulogne,France e Higher Education Research Unit, University of Versailles-St Quentin, Paris, France
a r t i c l e
i n f o
a b s t r a c t
Objective: To identify routine clinical, ultrasound, and biologic criteria to assess the volume of hemoperitoneum in women with ectopic pregnancy (EP). Methods: Except for patients with hemodynamic shock, all women assigned to surgical laparoscopictreatment for conﬁrmed EP at Poissy Saint Germain en Laye Hospital between January 2004 and December 2007 were included in the study. The patients underwent abdominal and digital pelvic examination, and standardized ultrasonography. Ordered logistic regression analysis was performed to select criteria associated with an increase in hemoperitoneum. The diagnostic accuracy of each variable was thencalculated for different hemoperitoneum cut-off values. Results: The study included 215 patients. Pelvic pain of 4 or above on a numeric rating scale (odds ratio [OR], 2.3; 95% conﬁdence interval [CI], 1.3–4.1), abdominal guarding or rebound tenderness (OR, 4.6; 95% CI, 2.0–10.8), hemoglobin under 10 g/dL (OR, 12.2; 95% CI, 4.2–35.8), presence of ﬂuid at transvaginal ultrasound (OR, 3.6; 95% CI,1.4–9.2), and ﬂuid in Morison pouch at abdominal ultrasound (OR, 5.6; 95% CI, 2.0–15.9) were found to be independently associated with hemoperitoneum. Conclusion: Both clinical examination and standardized ultrasonography were found to be useful for accurate evaluation of hemoperitoneum in patients presenting with EP. © 2011 International Federation of Gynecology and Obstetrics. Published by ElsevierIreland Ltd. All rights reserved.
Article history: Received 11 May 2011 Received in revised form 7 September 2011 Accepted 26 October 2011 Keywords: Ectopic pregnancy Gynecologic emergency Hemoperitoneum Ultrasound
1. Introduction Ectopic pregnancy (EP) occurs in 0.6% to 2.1% of all pregnancies in the United States , and accounts for up to 5% of all maternal deaths in high-resource countries. It is the main cause of mortality during the ﬁrst trimester of pregnancy . A combination of transvaginal ultrasound (TVUS) and serum human chorionic gonadotropin assay has been shown to be reliable for the early diagnosis of EP [4,5]. The goal of early diagnosis is the prevention of life-threatening hemodynamic failure caused by massive hemoperitoneum and active bleeding requiring surgicalexploration [6,7]. Massive hemoperitoneum (>500 mL) is thus 1 of the main indications for emergency surgery in EP. It is generally thought that evidence for hemoperitoneum will be found at ultrasound examination; nevertheless, the various ultrasound criteria used to quantify the amount of hemoperitoneum before surgery have not been validated [8–12]. In a previous retrospective explanatory study, a clinical model was developed to predict abundant hemoperitoneum on the basis of 3 criteria: spontaneous moderate-to-severe pelvic pain; ﬂuid
⁎ Corresponding author at: Department of Obstetrics and Gynecology, Poissy Saint Germain en Laye Hospital, 10 rue du Champ Gaillard, 78300 Poissy, France. Tel.: + 33 1 39 27 40 82; fax: + 33 1 39 27 44 79.
above the uterine fundus or around the...