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August 20, 1997, Vol 278, No. 7 >
ARTICLE | August 20, 1997

Is This Patient Pregnant?: Title and subTitle BreakCan You Reliably Rule In or Rule Out Early Pregnancy by Clinical Examination? FREE

Lori A. Bastian, MD, MPH; Joanne T. Piscitelli, MD
[+] Author Affiliations

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.


JAMA. 1997;278(7):586-591. doi:10.1001/jama.1997.03550070078042
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References

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.

REFERENCES

1 +
Scott JR, Disaia PJ, Hammond CB, Spellacy WN. Danforth's Obstetrics and Gynecology . 7th Ed. Philadelphia, Pa: JB Lippincott; 1994;.
2 +
Hibbard BM.  Pregnancy diagnosis . BMJ . 1971;;1:593-595.
3 +
Cunningham FG, MacDonald PC, Gant NF. Williams Obstetrics . 19th ed. East Norwalk, Conn: Appleton & Lange; 1993;.
4 +
Meeks GR, Casare CD, Bates GW.  Palpable uterine artery pulsation as a clinical indicator of early pregnancy . J Reprod Med . 1995;;40:194-196.
5 +
Bates B, Bickley LS, Hoekelman RA, Thompson JE. A Guide to Physical Examination and History Taking . 6th ed. Philadelphia, Pa: JB Lippincott; 1995;.
6 +
Chadwick JR.  Value of the bluish coloration of the vaginal entrance as a sign of pregnancy . Trans Am Gynecol Soc (1886) . 1887;;11:399-418.
7 +
McDonald E.  The diagnosis of early pregnancy, with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus . Am J Obstet Dis Women Child . 1908;;57:323-346.
8 +
O'Connor RE, Bibro CM, Pegg PJ, Bouzoukis JK.  The comparative sensitivity and specificity of serum and urine HCG determinations in the ED . Am J Emerg Med . 1993;;11:434-436.
9 +
Holleman DR, Simel DL.  Does the clinical examination predict pulmonary airflow obstruction? JAMA . 1995;;273:313-319.
10 +
 Correction : JAMA . 1995;;273:1334.
11 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies . J Clin Epidemiol . 1991;;8:763-770.
12 +
Stokes ME, Davis CS, Koch GG. Categorical Data Analysis Using the SAS System. Cary, NC: SAS Institute Inc; 1995.
13 +
Ramoska EA, Sacchetti AD, Nepp M.  Reliability of patient history in determining the possibility of pregnancy . Ann Emerg Med . 1989;;18:48-50.
14 +
Stengel CL, Seaberg DC, Macleod BA.  Pregnancy in the emergency department: risk factors and prevalence among all women . Ann Emerg Med . 1994;;24:697-700.
15 +
Bachman GA.  Myth or fact: can women self-diagnose pregnancy? J Med Soc N J . 1984;;81:857-858.
16 +
Robinson ET, Barber JH.  Early diagnosis of pregnancy in general practice . J R Coll Gen Prac . 1977;;27:335-338.
17 +
Zabin LS, Emerson MR, Ringers PA, Sedivy V.  Adolescents with negative pregnancy test results: an accessible at-risk group . JAMA . 1996;;275:113-117.
18 +
Jeng LL, Moore RM, Kaczmarek RG, Placek PJ, Bright RA.  How frequently are home pregnancy tests used? results from the 1988 National Maternal and Infant Health Survey . Birth . 1991;;18:11-13.
19 +
Caiola SM.  The pharmacist and home-use pregnancy tests . Am Pharm . 1992;;32:57-60.
20 +
Latman NS, Bruot BC.  Evaluation of home pregnancy test kits . Biomed Instrum Technol . 1989;;23:144-149.
21 +
Doshi ML.  Accuracy of consumer-performed inhome tests for early pregnancy detection . Am J Public Health . 1986;;76:512-514.
22 +
Daviaud J, Fournet D, Ballongue C, et al.  Reliability and feasibility of pregnancy home-use tests: laboratory validation and diagnostic evaluation by 638 volunteers . Clin Chem . 1993;;39:53-59.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Scott JR, Disaia PJ, Hammond CB, Spellacy WN. Danforth's Obstetrics and Gynecology . 7th Ed. Philadelphia, Pa: JB Lippincott; 1994;.
2 +
Hibbard BM.  Pregnancy diagnosis . BMJ . 1971;;1:593-595.
3 +
Cunningham FG, MacDonald PC, Gant NF. Williams Obstetrics . 19th ed. East Norwalk, Conn: Appleton & Lange; 1993;.
4 +
Meeks GR, Casare CD, Bates GW.  Palpable uterine artery pulsation as a clinical indicator of early pregnancy . J Reprod Med . 1995;;40:194-196.
5 +
Bates B, Bickley LS, Hoekelman RA, Thompson JE. A Guide to Physical Examination and History Taking . 6th ed. Philadelphia, Pa: JB Lippincott; 1995;.
6 +
Chadwick JR.  Value of the bluish coloration of the vaginal entrance as a sign of pregnancy . Trans Am Gynecol Soc (1886) . 1887;;11:399-418.
7 +
McDonald E.  The diagnosis of early pregnancy, with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus . Am J Obstet Dis Women Child . 1908;;57:323-346.
8 +
O'Connor RE, Bibro CM, Pegg PJ, Bouzoukis JK.  The comparative sensitivity and specificity of serum and urine HCG determinations in the ED . Am J Emerg Med . 1993;;11:434-436.
9 +
Holleman DR, Simel DL.  Does the clinical examination predict pulmonary airflow obstruction? JAMA . 1995;;273:313-319.
10 +
 Correction : JAMA . 1995;;273:1334.
11 +
Simel DL, Samsa GP, Matchar DB.  Likelihood ratios with confidence: sample size estimation for diagnostic test studies . J Clin Epidemiol . 1991;;8:763-770.
12 +
Stokes ME, Davis CS, Koch GG. Categorical Data Analysis Using the SAS System. Cary, NC: SAS Institute Inc; 1995.
13 +
Ramoska EA, Sacchetti AD, Nepp M.  Reliability of patient history in determining the possibility of pregnancy . Ann Emerg Med . 1989;;18:48-50.
14 +
Stengel CL, Seaberg DC, Macleod BA.  Pregnancy in the emergency department: risk factors and prevalence among all women . Ann Emerg Med . 1994;;24:697-700.
15 +
Bachman GA.  Myth or fact: can women self-diagnose pregnancy? J Med Soc N J . 1984;;81:857-858.
16 +
Robinson ET, Barber JH.  Early diagnosis of pregnancy in general practice . J R Coll Gen Prac . 1977;;27:335-338.
17 +
Zabin LS, Emerson MR, Ringers PA, Sedivy V.  Adolescents with negative pregnancy test results: an accessible at-risk group . JAMA . 1996;;275:113-117.
18 +
Jeng LL, Moore RM, Kaczmarek RG, Placek PJ, Bright RA.  How frequently are home pregnancy tests used? results from the 1988 National Maternal and Infant Health Survey . Birth . 1991;;18:11-13.
19 +
Caiola SM.  The pharmacist and home-use pregnancy tests . Am Pharm . 1992;;32:57-60.
20 +
Latman NS, Bruot BC.  Evaluation of home pregnancy test kits . Biomed Instrum Technol . 1989;;23:144-149.
21 +
Doshi ML.  Accuracy of consumer-performed inhome tests for early pregnancy detection . Am J Public Health . 1986;;76:512-514.
22 +
Daviaud J, Fournet D, Ballongue C, et al.  Reliability and feasibility of pregnancy home-use tests: laboratory validation and diagnostic evaluation by 638 volunteers . Clin Chem . 1993;;39:53-59.

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