The Relationship between Quantitative B-hCG Levels and Ectopic Pregnancy in an Emergency Department Cohort: Development of an Evidence-Based Clinical Pathway

2.50
Hdl Handle:
http://hdl.handle.net/10755/149601
Type:
Presentation
Title:
The Relationship between Quantitative B-hCG Levels and Ectopic Pregnancy in an Emergency Department Cohort: Development of an Evidence-Based Clinical Pathway
Abstract:
The Relationship between Quantitative B-hCG Levels and Ectopic Pregnancy in an Emergency Department Cohort: Development of an Evidence-Based Clinical Pathway
Conference Sponsor:Sigma Theta Tau International
Conference Year:2007
Author:Strout, Tania D., RN, BSN
P.I. Institution Name:Maine Medical Center
Title:Research Nurse
Co-Authors:Michael R. Baumann, MD, FACEP; Rebecca B. Bloch, MD
[Leadership session research presentation] Purpose: Ectopic pregnancy is a serious condition with significant morbidity and mortality. Despite evidence that B-hCG levels do not fluctuate as expected in women with ectopic or abnormal pregnancies, many hospitals use the concept of a ?discriminatory zone? where women with a B-hCG below a cut-point do not receive a transvaginal ultrasound. The purpose of this investigation was to evaluate the relationship between quantitative B-hCG levels and ectopic pregnancy in an emergency department (ED) population. Methods: Rodgers? Science of Unitary Human Beings served as the theoretical framework for this IRB exempted health records survey. Data for women presenting to the ED with vaginal bleeding and/or abdominal pain who underwent both B-hCG testing and transvaginal ultrasound for the period from 10/1/03 to 9/30/05 was collected and analyzed. Results: 337 visits meeting inclusion criteria were identified.  Twenty-one subjects (6.23%) had confirmed ectopic pregnancy, 10 were ruptured and 11 were unruptured. No statistically significant difference in mean B-hCG level was identified in those subjects with ruptured versus unruptured ectopic pregnancy (t=0.115, df=19, p=0.910). A statistically significant difference in days gestation was noted when comparing ruptured and unruptured ectopics (t=3.086, df=18, p=0.006). Mean days gestation for women with ruptured ectopics were 32.8 +/- 12.3, 95% CI: 24.0 to 41.5 days, while days gestation for unruptured ectopic pregnancies were 48.1 +/- 9.78, 95% CI: 41.1 to 55.1. Conclusions: In this cohort, ectopic pregnancy was associated with low B-hCG levels. Both ruptured and unruptured ectopic pregnancy occurred at B-hCG levels below traditional cut-points. Low B-hCG levels should not be used to exclude the possibility of ectopic pregnancy in women with vaginal bleeding or abdominal pain and short-term gestation. The results of this study were used to create an evidence-based guideline for the evaluation of women presenting to the ED with symptoms suggestive of ectopic pregnancy.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Relationship between Quantitative B-hCG Levels and Ectopic Pregnancy in an Emergency Department Cohort: Development of an Evidence-Based Clinical Pathwayen_GB
dc.identifier.urihttp://hdl.handle.net/10755/149601-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Relationship between Quantitative B-hCG Levels and Ectopic Pregnancy in an Emergency Department Cohort: Development of an Evidence-Based Clinical Pathway</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Strout, Tania D., RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Maine Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Nurse</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">strout@mmc.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Michael R. Baumann, MD, FACEP; Rebecca B. Bloch, MD</td></tr><tr><td colspan="2" class="item-abstract">[Leadership session research presentation] Purpose: Ectopic pregnancy is a serious condition with significant morbidity and mortality. Despite evidence that B-hCG levels do not fluctuate as expected in women with ectopic or abnormal pregnancies, many hospitals use the concept of a ?discriminatory zone? where women with a B-hCG below a cut-point do not receive a transvaginal ultrasound. The purpose of this investigation was to evaluate the relationship between quantitative B-hCG levels and ectopic pregnancy in an emergency department (ED) population. Methods: Rodgers? Science of Unitary Human Beings served as the theoretical framework for this IRB exempted health records survey. Data for women presenting to the ED with vaginal bleeding and/or abdominal pain who underwent both B-hCG testing and transvaginal ultrasound for the period from 10/1/03 to 9/30/05 was collected and analyzed. Results: 337 visits meeting inclusion criteria were identified.&nbsp; Twenty-one subjects (6.23%) had confirmed ectopic pregnancy, 10 were ruptured and 11 were unruptured. No statistically significant difference in mean B-hCG level was identified in those subjects with ruptured versus unruptured ectopic pregnancy (t=0.115, df=19, p=0.910). A statistically significant difference in days gestation was noted when comparing ruptured and unruptured ectopics (t=3.086, df=18, p=0.006). Mean days gestation for women with ruptured ectopics were 32.8 +/- 12.3, 95% CI: 24.0 to 41.5 days, while days gestation for unruptured ectopic pregnancies were 48.1 +/- 9.78, 95% CI: 41.1 to 55.1. Conclusions: In this cohort, ectopic pregnancy was associated with low B-hCG levels. Both ruptured and unruptured ectopic pregnancy occurred at B-hCG levels below traditional cut-points. Low B-hCG levels should not be used to exclude the possibility of ectopic pregnancy in women with vaginal bleeding or abdominal pain and short-term gestation. The results of this study were used to create an evidence-based guideline for the evaluation of women presenting to the ED with symptoms suggestive of ectopic pregnancy.</td></tr></table>en_GB
dc.date.available2011-10-26T10:05:41Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T10:05:41Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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