Imperial College London
Alternate

Professor Tom Bourne

Faculty of Medicine, Department of Metabolism, Digestion and Reproduction

Chair in Gynaecology
 
 
 
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Contact

 

+44 (0)20 3313 5131t.bourne Website

 
 
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Location

 

Early pregnancy and acute gynaecologyInstitute of Reproductive and Developmental BiologyHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bobdiwala:2020:10.1002/uog.20420,
author = {Bobdiwala, S and Christodoulou, E and Farren, J and Mitchell-Jones, N and Kyriacou, C and Al-Memar, M and Ayim, F and Chohan, B and Kirk, E and Abughazza, O and Guruwadahyarhalli, B and Guha, S and Vathanan, V and Bottomley, C and Gould, D and Stalder, C and Timmerman, D and Van, Calster B and Bourne, T},
doi = {10.1002/uog.20420},
journal = {Ultrasound in Obstetrics and Gynecology},
pages = {105--114},
title = {Triaging women with pregnancy of unknown location using twostep protocol including M6 model: clinical implementation study},
url = {http://dx.doi.org/10.1002/uog.20420},
volume = {55},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - INTRODUCTION: The M6 risk prediction model has been shown to have good triage performance for stratifying women with a PUL as being at low or high-risk of harboring an ectopic pregnancy. There is evidence that M6 has better overall test performance than the hCG ratio (serum hCG at 48 hours/hCG at presentation) and older models such as the M4 model. M6 was published as part of a two-step protocol using an initial progesterone ≤2nmol/l to identify likely failing pregnancies (step 1), followed by M6 (step 2). This study validated the triage performance of this protocol in clinical practice by evaluating (1) the number of protocol-related adverse events and (2) how patients are effectively triaged. METHODS: This was a prospective multi-centre interventional study of 3272 women with a PUL carried out between January 2015 and January 2017 in four district general hospitals and four university teaching hospitals in the United Kingdom. We defined the final pregnancy outcome as: a failed PUL (FPUL), an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP) (including persistent PUL (PPUL)). FPUL and IUP were grouped as low-risk and EP and PPUL as high-risk PUL. Patients had a serum progesterone and hCG level at 0 hours and repeat hCG at 48 hours. In seven centres, if the initial progesterone was ≤2nmol/l, patients were discharged with a follow-up urine pregnancy test in two weeks to confirm a negative result. If the progesterone was >2nmol/l or had not been taken, a 48 hour hCG level was taken and results entered into the M6 model. Patients were managed according to their predicted outcome: those classified with pregnancies likely to resolve (FPUL) were advised to perform a urine pregnancy test in two weeks and those with a likely IUP were invited for a scan a week later. When a women with a PUL was classified as high-risk (i.e. those with a risk of EP ≥ 5%) were reviewed clinically within 48 hours. One centre used a progesterone cut-off ≤10nmol/l an
AU  - Bobdiwala,S
AU  - Christodoulou,E
AU  - Farren,J
AU  - Mitchell-Jones,N
AU  - Kyriacou,C
AU  - Al-Memar,M
AU  - Ayim,F
AU  - Chohan,B
AU  - Kirk,E
AU  - Abughazza,O
AU  - Guruwadahyarhalli,B
AU  - Guha,S
AU  - Vathanan,V
AU  - Bottomley,C
AU  - Gould,D
AU  - Stalder,C
AU  - Timmerman,D
AU  - Van,Calster B
AU  - Bourne,T
DO  - 10.1002/uog.20420
EP  - 114
PY  - 2020///
SN  - 0960-7692
SP  - 105
TI  - Triaging women with pregnancy of unknown location using twostep protocol including M6 model: clinical implementation study
T2  - Ultrasound in Obstetrics and Gynecology
UR  - http://dx.doi.org/10.1002/uog.20420
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31385381
UR  - http://hdl.handle.net/10044/1/72547
VL  - 55
ER  -
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