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

B. W J Mol, Petra J. Hajenius, Simone Engelsbel, Willem M. Ankum, Fulco Van Der Veen, Douwe J. Hemrika, P. M M Bossuyt

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41 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)167-173
Number of pages7
JournalFertility and Sterility
Issue number1
Publication statusPublished or Issued - Jan 1999


  • Ectopic pregnancy
  • Noninvasive diagnosis
  • Tubal rupture

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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