Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography

Ralph Wang, Teri A. Reynolds, Hugh H. West, Deepa Ravikumar, Christina Martinez, Ian McAlpine, Vanessa L. Jacoby, John C. Stein

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Study objective: We seek to assess the performance of the β human chorionic gonadotropin (β-hCG) "discriminatory zone" when using bedside pelvic ultrasonography in the evaluation of symptomatic pregnant emergency department (ED) patients. Methods: This was a cross-sectional study of bedside pelvic ultrasonography performed on consecutive pregnant patients in the first trimester who presented to the ED with abdominal pain or vaginal bleeding. Patients received pelvic ultrasonography, serum β-hCG testing, and blinded formal radiologic ultrasonography. All patients were followed for 8 weeks to determine outcomes. The sensitivity and specificity of a discriminatory β-hCG level of 3,000 mIU/mL for the diagnosis of ectopic pregnancy were calculated for patients without an intrauterine pregnancy visualized by bedside ultrasonography. Results: Thirty-six faculty physicians performed bedside pelvic ultrasonography on 256 patients. There were 161 cases with a confirmed visualizable intrauterine pregnancy and 29 ectopic pregnancies. Bedside ultrasonography identified 115 intrauterine pregnancies. The range of β-hCG for cases of confirmed visualizable intrauterine pregnancy with a nondiagnostic bedside ultrasonography was 15 mIU/mL to 123,368 mIU/mL (median 6,633; interquartile range 1,551 to 32,699). For patients with nondiagnostic bedside ultrasonography, using a discriminatory β-hCG level of 3,000 mIU/mL to further assess for ectopic pregnancy showed sensitivity of 35% (95% confidence interval [CI] 18% to 54%) and specificity of 58% (95% CI 48% to 67%). Finally, the overall sensitivity of bedside pelvic ultrasonography for the detection of intrauterine pregnancy was 71% (95% CI 63% to 78%), and the specificity was 99% (95% CI 94% to 100%). Conclusion: When bedside pelvic ultrasonography does not demonstrate an intrauterine pregnancy, serum β-hCG level is not helpful in differentiating intrauterine from ectopic pregnancy in symptomatic ED patients.

Original languageEnglish (US)
Pages (from-to)12-20
Number of pages9
JournalAnnals of Emergency Medicine
Volume58
Issue number1
DOIs
StatePublished - Jul 2011
Externally publishedYes

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Ultrasonography
Ectopic Pregnancy
Pregnancy
Confidence Intervals
Hospital Emergency Service
Uterine Hemorrhage
Chorionic Gonadotropin
First Pregnancy Trimester
Serum
Abdominal Pain
Cross-Sectional Studies
Physicians
Sensitivity and Specificity

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Wang, R., Reynolds, T. A., West, H. H., Ravikumar, D., Martinez, C., McAlpine, I., ... Stein, J. C. (2011). Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Annals of Emergency Medicine, 58(1), 12-20. https://doi.org/10.1016/j.annemergmed.2010.12.023

Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. / Wang, Ralph; Reynolds, Teri A.; West, Hugh H.; Ravikumar, Deepa; Martinez, Christina; McAlpine, Ian; Jacoby, Vanessa L.; Stein, John C.

In: Annals of Emergency Medicine, Vol. 58, No. 1, 07.2011, p. 12-20.

Research output: Contribution to journalArticle

Wang, R, Reynolds, TA, West, HH, Ravikumar, D, Martinez, C, McAlpine, I, Jacoby, VL & Stein, JC 2011, 'Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography', Annals of Emergency Medicine, vol. 58, no. 1, pp. 12-20. https://doi.org/10.1016/j.annemergmed.2010.12.023
Wang R, Reynolds TA, West HH, Ravikumar D, Martinez C, McAlpine I et al. Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. Annals of Emergency Medicine. 2011 Jul;58(1):12-20. https://doi.org/10.1016/j.annemergmed.2010.12.023
Wang, Ralph ; Reynolds, Teri A. ; West, Hugh H. ; Ravikumar, Deepa ; Martinez, Christina ; McAlpine, Ian ; Jacoby, Vanessa L. ; Stein, John C. / Use of a β-hCG discriminatory zone with bedside pelvic ultrasonography. In: Annals of Emergency Medicine. 2011 ; Vol. 58, No. 1. pp. 12-20.
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