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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.

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