To rule out ectopic pregnancy in patients who are symptomatic in the early stages of pregnancy, emergency physicians (EPs) must first confirm an intrauterine pregnancy (IUP). The IUPs must then have their viability evaluated. Even though transvaginal ultrasound (TVUS) is the optimum modality for these patients, most emergency settings do not have access to it. For a study, researchers sought to ascertain the impact of high-frequency linear transducers (HFLT) on the precision of point-of-care ultrasound (POCUS) for identifying IUP and the degree of concordance in patient diagnosis between EPs and obstetricians.
Pregnant patients who visited the emergency department (ED) complaining of vaginal bleeding and abdominopelvic discomfort were included in a convenience sample. The features of transabdominal POCUS diagnostic procedures carried out by EPs were contrasted with TVUS.
The total number of participants in the research was 143. POCUS had a diagnostic accuracy for the definitive IUP of 93.0%, with a sensitivity of 89.0%, a specificity of 100%, and an accuracy for POCUS with HFLT of 97.9%, with a sensitivity of 96.7%, a specificity of 100%. Utilizing HFLT increased the diagnostic accuracies for the detection of fetal cardiac activity (FCA) to 97.9% (from 94.4%) and sensitivity to 95.5% (from 88.1%). Additionally, there was significant agreement between the EPs and obstetricians on the classification of ED diagnoses (agreement: 96.5%, kappa: 0.943, P<0.0001).
When comparing TVUS conducted by obstetricians to POCUS plus HFLT performed by EPs in symptomatic patients in their first trimester of pregnancy, the accuracy is improved to a non-inferior level. As a result, EPs may trust POCUS to verify IUP and FCA. However, they should use caution when using it to rule anything out. Furthermore, the use of HFLT as an alternative to TVUS might improve the precision of POCUS in viability evaluation.
Reference: sciencedirect.com/science/article/abs/pii/S0735675722005496
