 |
 |

Is This Patient Pregnant?Can You Reliably Rule In or Rule Out Early Pregnancy by Clinical Examination?
Lori A. Bastian, MD, MPH;
Joanne T. Piscitelli, MD
JAMA. 1997;278(7):586-591.
Abstract
This review addresses a common problem facing the clinician: "When treating or evaluating a woman of childbearing years, what is the value of historical or physical examination features in determining the probability of early pregnancy?" We focus on the clinical examination findings that may help the clinician rule in or rule out early pregnancy. Generally accepted indicators of pregnancy include amenorrhea, morning sickness, tender or tingling breasts, and, after 8 weeks' gestational age, an enlarged uterus with a soft cervix. We reviewed the value (ie, sensitivity and specificity) of these indicators, as well as home pregnancy test results, as predictors of the diagnosis of early pregnancy. The available evidence suggests that some historical features, when absent, are fair but not reliable for ruling out pregnancy. When diagnosing early pregnancy, the clinician should not rely on the clinical examination or a home pregnancy test—a laboratory test should be requested.
Author Affiliations
From the Departments of Internal Medicine (Dr Bastian) and Obstetrics and Gynecology (Drs Bastian and Piscitelli), Duke University Medical Center, Durham, NC; and the Women Veteran Comprehensive Health Center and the Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham (Dr Bastian).
Footnotes
Reprints: Lori A. Bastian, MD, MPH, Health Services Research, Veterans Affairs Medical Center, Mail Code 152, 508 Fulton St, Durham, NC 27705 (e-mail: LBASTIAN@acpub.duke.edu).
The Rational Clinical Examination section editors: David L. Simel, MD, MHS, Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC; Drummond Rennie, MD, Deputy Editor (West), JAMA.
CiteULike Connotea Del.icio.us Digg Reddit Technorati
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Prospective Comparative Trial of Endovaginal Sonographic Bimanual Examination Versus Traditional Digital Bimanual Examination in Nonpregnant Women With Lower Abdominal Pain With Regard to Body Mass Index Classification
Tayal et al.
J Ultrasound Med 2008;27:1171-1177.
ABSTRACT
| FULL TEXT
Patient self assessment of pregnancy status in the emergency department.
Strote and Chen
Emerg. Med. J. 2006;23:554-557.
ABSTRACT
| FULL TEXT
Detection of Early Pregnancy Forms of Human Chorionic Gonadotropin by Home Pregnancy Test Devices
Butler et al.
Clin. Chem. 2001;47:2131-2136.
ABSTRACT
| FULL TEXT
|