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{Christodoulou:2021:10.1111/1471-0528.16497,
author = {Christodoulou, E and Bobdiwala, S and Kyriacou, C and Farren, J and Mitchell-Jones, N and Ayim, F and Chohan, B and Abughazza, O and Guruwadahyarhalli, B and Al-Memar, M and Guha, S and Vathanan, V and Gould, D and Stalder, C and Wynants, L and Timmerman, D and Bourne, T and Van, Calster B},
doi = {10.1111/1471-0528.16497},
journal = {BJOG: an International Journal of Obstetrics and Gynaecology},
pages = {552--562},
title = {External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.},
url = {http://dx.doi.org/10.1111/1471-0528.16497},
volume = {128},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - OBJECTIVE: To externally validate five approaches to predict ectopic pregnancy (EP) in pregnancies of unknown location (PUL): the M6P and M6NP risk models, the two-step triage strategy (2ST, which incorporates M6P), the M4 risk model, and beta human chorionic gonadotropin ratio cut-offs (BhCG-RC). DESIGN: Secondary analysis of a prospective cohort study. SETTING: Eight UK early pregnancy assessment units. POPULATION: Women presenting with a PUL and BhCG >25 IU/L. METHODS: Women were managed using the 2ST protocol: PUL were classified as low risk of EP if presenting progesterone ≤2 nmol/L; the remaining cases returned two days later for triage based on M6P. EP risk ≥5% was used to classify PUL as high risk. Missing values were imputed, and predictions for the five approaches were calculated post hoc. We meta-analysed centre-specific results. MAIN OUTCOME MEASURES: Discrimination, calibration and clinical utility (decision curve analysis) for predicting EP. RESULTS: Of 2899 eligible women, the primary analysis excluded 297 (1 0%) women who were lost to follow-up. The area under the ROC curve for EP was 0.89 (95% confidence interval 0.86-0.91) for M6P, 0.88 (0.86-0.90) for 2ST, 0.86 (0.83-0.88) for M6NP, and 0.82 (0.78-0.85) for M4. Sensitivities for EP were 96% (M6P), 94% (2ST), 92% (N6NP), 80% (M4), and 58% (BhCG-RC); false positive rates were 35%, 33%, 39%, 24%, and 13%. M6P and 2ST had the best clinical utility and good overall calibration, with modest variability between centres. CONCLUSIONS: 2ST and M6P performed best to predict and triage PUL.
AU  - Christodoulou,E
AU  - Bobdiwala,S
AU  - Kyriacou,C
AU  - Farren,J
AU  - Mitchell-Jones,N
AU  - Ayim,F
AU  - Chohan,B
AU  - Abughazza,O
AU  - Guruwadahyarhalli,B
AU  - Al-Memar,M
AU  - Guha,S
AU  - Vathanan,V
AU  - Gould,D
AU  - Stalder,C
AU  - Wynants,L
AU  - Timmerman,D
AU  - Bourne,T
AU  - Van,Calster B
DO  - 10.1111/1471-0528.16497
EP  - 562
PY  - 2021///
SN  - 1470-0328
SP  - 552
TI  - External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.
T2  - BJOG: an International Journal of Obstetrics and Gynaecology
UR  - http://dx.doi.org/10.1111/1471-0528.16497
UR  - https://www.ncbi.nlm.nih.gov/pubmed/32931087
UR  - https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16497
UR  - http://hdl.handle.net/10044/1/82923
VL  - 128
ER  -
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