Imperial College London
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Mr SRDJAN SASO

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)7890 795 182srdjan.saso01

 
 
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Location

 

Institute of Reproductive and Developmental BiologyHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bobdiwala:2019:10.1111/1471-0528.15442,
author = {Bobdiwala, S and Saso, S and Verbakel, JY and Al-Memar, M and Van, Calster B and Timmerman, D and Bourne, T},
doi = {10.1111/1471-0528.15442},
journal = {BJOG: An International Journal of Obstetrics and Gynaecology},
pages = {190--198},
title = {Diagnostic protocols for the management of pregnancy of unknown location: a systematic review and meta-analysis},
url = {http://dx.doi.org/10.1111/1471-0528.15442},
volume = {126},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BACKGROUND: There is no international consensus on how to manage women with a pregnancy of unknown location (PUL). OBJECTIVES: To present a systematic quantitative review summarising the evidence related to management protocols for PUL. SEARCH STRATEGY: MEDLINE, COCHRANE and DARE databases were searched from 01/01/1984 to 31/01/2017. The primary outcome was accurate risk prediction of women initially diagnosed with a PUL having an ectopic pregnancy (high risk) as opposed to either a failed PUL or intrauterine pregnancy ((low risk). SELECTION CRITERIA: All studies written in the English language, that were not case reports or series that assessed women classified as having a PUL at initial ultrasound. DATA COLLECTION AND ANALYSIS: Forty-three studies were included. QUADAS-2 criteria were used to assess the risk of bias. We used a novel linear mixed effects model and constructed summary receiver operating characteristic (SROC) curves for the thresholds of interest. MAIN RESULTS: There was a high risk of differential verification bias in most studies. Meta-analyses of accuracy were performed on (i) single hCG cut-off levels, (ii) hCG ratio (hCG at 48 hours / initial hCG), (iii) single progesterone cut-off levels and (iv) the 'M4 model' (a logistic regression model based on the initial hCG and hCG ratio). For predicting an ectopic pregnancy, the AUCs (95% CI) for these four management protocols were: (i) 0.42 (0.00-0.99), (ii) 0.69 (0.57-0.78), (iii) 0.69 (0.54-0.81) and (iv) 0.87 (0.83-0.91), respectively. CONCLUSIONS: The M4 model was the best available method for predicting a final outcome of ectopic pregnancy. Developing and validating risk prediction models may optimise the management of PUL.
AU  - Bobdiwala,S
AU  - Saso,S
AU  - Verbakel,JY
AU  - Al-Memar,M
AU  - Van,Calster B
AU  - Timmerman,D
AU  - Bourne,T
DO  - 10.1111/1471-0528.15442
EP  - 198
PY  - 2019///
SN  - 1470-0328
SP  - 190
TI  - Diagnostic protocols for the management of pregnancy of unknown location: a systematic review and meta-analysis
T2  - BJOG: An International Journal of Obstetrics and Gynaecology
UR  - http://dx.doi.org/10.1111/1471-0528.15442
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30129999
UR  - http://hdl.handle.net/10044/1/61983
VL  - 126
ER  -
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