Management of suspected ectopic pregnancy. Impact of new diagnostic tools in 686 consecutive cases

OBJECTIVE: To analyze the impact of new diagnostic tools on the use of laparoscopy on patients with suspected ectopic pregnancy (EP). STUDY DESIGN: Analysis of 686 consecutive patients who underwent laparoscopy or laparotomy for suspected EP from 1983 to 1995 at the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. RESULTS: With the introduction of more sensitive urine pregnancy tests, the positive predictive value (PPV) of diagnostic management increased from 0.42 in 1983 to 0.91 in 1988. The introduction of transvaginal sonography improved this figure to 0.93 in 1989. More recently, a PPV of 0.95 was achieved by adding serum human chorionic gonadotropin measurements to the diagnostic workup. The sensitivity and specificity of this new strategy were 0.97 and 0.96. CONCLUSION: New diagnostic methods greatly reduced the need for laparoscopy to diagnose or rule out EP. The largest impact resulted from the introduction of better pregnancy tests. The effect of other sophisticated tools was less dramatic but eventually contributed to a near perfect noninvasive diagnostic management, thus opening new perspectives for nonoperative treatment modalities