Is this patient pregnant? Can you reliably rule in or rule out early pregnancy by clinical examination?
L. A. Bastian and J. T. Piscitelli
Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA. lbastian@acpub.duke.edu
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.
