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Retrospective study: intradecidual sign excludes ectopic pregnancy.

PHOENIX, ARIZ. -- The intradecidual sign of early intrauterine pregnancy reliably excludes the possibility of ectoptic pregnancy, results from a retrospective study suggest.

In addition, the sensitivity for diagnosis of an intrauterine pregnancy increases when the HCG levels are greater than or equal to 2,000 mIU/mL or the mean sac diameter is greater than or equal to 3 mm, Gloria Chiang reported at the annual meeting of the American Institute of Ultrasound in Medicine.

She and her associates assessed 187 pregnant patients in whom transvaginal sonography revealed an intrauterine collection without a yolk sac or embryo.

The intradecidual sign of early intrauterine pregnancy was defined as fluid collection with a slightly echogenic rim located adjacent to the central endometrial cavity.

The pseudosac of ectopic pregnancy was defined as fluid collection located centrally in the endometrial cavity.

For each case investigators selected four images that best showed fluid collection within the endometrium. Three reviewers used a 1-5 scale to score the appearance of the intradecidual sign, with 1 meaning "definitely not present" and 5 meaning "definitely present."

Follow-up revealed 104 cases of intrauterine pregnancy, 49 cases of spontaneous abortion, and 34 cases of ectopic pregnancy, said Ms. Chiang, who is a student at Harvard Medical School, Boston.

Among the three reviewers, the sensitivity for diagnosis of intrauterine pregnancy was 60%-68%; specificity was 97%-100%; accuracy was 68%-73%, positive predictive value was 99%-100%, and the negative predictive value was 36%-40%.

For the subgroup of cases in which HCG levels were greater than or equal to 2,000 mIU/mL, the sensitivity for diagnosis of intradecidual sign increased to 88%.

For the subgroup of cases in which the mean sac diameter was greater than or equal to 3 mm, the sensitivity for diagnosis was 81%.

Possible limitations of the study, include the fact that "there might have been some sort of selection bias, either in the choice of images, or from the choice of cases," Ms. Chiang said.

BY DOUG BRUNK

San Diego Bureau
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Title Annotation:Obstetrics
Author:Brunk, Doug
Publication:OB GYN News
Date:Aug 15, 2004
Words:336
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