Table 6.5GRADE summary of findings for the diagnosis of ectopic pregnancy using two or more hCG measurements

Number of studiesNumber of womenMeasure of diagnostic accuracyQuality
Sensitivity % (95% CI)Specificity % (95% CI)Positive predictive value % (95% CI)Negative predictive value % (95% CI)Positive likelihood ratio (95% CI)Negative likelihood ratio (95% CI)
% change in serum hCG in 48 hours: decline, or rise of < 50 %
1 study

(Mol et al., 1998)
19568.4

(53.6 to 83.2)*
11.5

(6.5 to 16.5)*
15.8

(10.2 to 21.3)*
60.0

(42.5 to 77.5)*
0.77

(0.62 to 0.97)*
2.75

(1.45 to 5.22)*
Low
% change in serum hCG in 48 hours: decline, or rise of < 63 %
1 study

(Daus et al., 1989)
35793.6

(86.6 to 100)*
18.4

(14.1 to 22.7)*
14.8

(10.8 to 18.9)*
95.0

(89.5 to 100)*
1.15

(1.05 to 1.26)*
0.35

(0.11 to 1.06)*
Very low
% change in serum hCG in 48 hours: decline, or rise of < 66 %
1 study

(Dart et al., 1999)
30781.8

(68.7 to 95.0)*
16.8

(12.4 to 21.2)*
10.6

(6.8 to 14.4)*
88.5

(79.8 to 97.2)*
0.98

(0.83 to 1.16)*
1.08

(0.50 to 2.34)*
Low
% change in serum hCG in 48 hours: between a decline of 36-47% and a rise of 35%
1 study

(Morse et al., 2012)
100583.2

(77.7 to 88.8)
70.8

(67.7 to 73.9)
38.2

(33.4 to 43.0)
95.1

(93.4 to 96.8)
not reported (NR)NRVery low
% change in serum hCG in 48 hours: between a decline of 36-47% and a rise of 53%
1 study

(Morse et al., 2012)
100591.1

(86.8 to 95.3)
66.6

(63.4 to 69.8)
37.1

(32.6 to 41.7)
97.2

(95.8 to 98.5)
NRNRVery low
% change in serum hCG in 48 hours: between a decline of 36-47% and a rise of 71%
1 study

(Morse et al., 2012)
100592.2

(88.2 to 96.2)
62.8

(59.5 to 66.1)
35.0

(30.6 to 39.3)
97.4

(96.0 to 98.7)
NRNRVery low
Rate of change of log hCG: < 0.11
1 study

(Stewart et al., 1995)
3689.7

(81.8 to 97.5)*
37.3

(25.0 to 49.6)*
58.4

(48.2 to 68.7)*
78.6

(63.4 to 93.8)*
1.43

(1.15 to 1.77)*
0.28

(0.12 to 0.63)*
Very low
Rate of change of log hCG: < 0.14
1 study

(Stewart et al., 1995)
3698.3

(94.9 to 100)*
22.0

(11.5 to 32.6)*
55.3

(45.7 to 64.9)*
92.9

(79.4 to 100)*
1.26

(1.10 to 1.45)*
0.08

(0.01 to 0.58)*
Very Low
Abnormal hCG score
1 study

(Hahlin et al., 1991)
30788.7

(83.8 to 93.6)*
47.3

(39.3 to 55.3)*
64.4

(58.0 to 70.7)*
79.6

(71.1 to 88.0)*
1.68

(1.43 to 1.98)*
0.24

(0.15 to 0.38)*
Low
1 study

(Thorburn et al., 1992)
26181.1

(73.0 to 89.2)*
43.9

(36.4 to 51.3)*
43.2

(35.7 to 50.7)*
81.5

(73.6 to 89.5)*
1.44

(1.22 to 1.71)*
0.43

(0.27 to 0.68)*
Low
Model M1: using probability thresholds
1 study

(Condous et al., 2004)
19683.3

(62.3 to 100)
88.0

(83.4 to 92.7)
31.3

(15.2 to 47.3)
98.8

(97.1 to 100)
6.97

(4.37 to 11.11)*
0.19

(0.05 to 0.67)*
Low
Model M1: using costs 1, 1 and 4
1 study

(Condous et al., 2004)
19683.3

(62.3 to 100)
86.4

(81.5 to 91.4)
28.6

(13.6 to 43.5)
98.8

(97.1 to 100)
6.13

(3.94 to 9.56)*
0.19

(0.05 to 0.68)*
Low
1 study

(Condous et al., 2007)
17373.3

(51.0 to 95.7)
87.3

(82.2 to 92.5)
35.5

(18.6 to 52.3)
97.2

(94.5 to 99.9)
5.79

(3.48 to 9.66)
0.31

(0.13 to 0.71)
Low
Model M1: using costs 1, 1 and 5
1 study

(Condous et al., 2004)
19691.7

(76.0 to 100)
84.2

(79.0 to 89.5)
27.5

(13.7 to 41.3)
99.4

(98.1 to 100)
5.82

(4.00 to 8.46)*
0.10

(0.02 to 0.65)*
Low
Model M4
1 study

(Condous et al., 2007)
17380.0

(59.8 to 100)
88.6

(83.7 to 93.6)
40.0

(22.5 to 57.5)
97.9

(95.6 to 100)
7.02

(4.25 to 11.61)
0.23

(0.08 to 0.62)
Low
1 study
(Barnhart et al., 2010)

(2 included cohorts: UK and adjusted USA)
43180.8

(65.6 to 95.9)
88.9

(85.8 to 92.0)
31.8

(20.6 to 43.1)
98.6

(97.4 to 99.8)
7.27

(5.21 to 10.14)*
0.22

(0.10 to 0.48)*
Very low
54454.8

(45.2 to 64.4)
87.7

(84.7 to 90.8)
51.4

(42.1 to 60.7)
89.2

(86.2 to 92.1)
4.47

(3.29 to 6.06)*
0.52

(0.46 to 0.64)*
Very low

CI confidence interval, hCG β-human chorionic gonadotrophin, NR not reported

*

Calculated by NCC-WCH technical team

There were 36 women who received multiple hCG measurements, leading to a total of 117 pairs of hCG measurement used for the diagnostic accuracy calculations

Confidence intervals calculated by NCC-WCH technical team

Calculated by NCC-WCH technical team

There were 36 women who received multiple hCG measurements, leading to a total of 117 pairs of hCG measurement used for the diagnostic accuracy calculations

Confidence intervals calculated by NCC-WCH technical team

From: 6, Diagnosis of ectopic pregnancy and miscarriage

Cover of Ectopic Pregnancy and Miscarriage
Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management in Early Pregnancy of Ectopic Pregnancy and Miscarriage.
NICE Clinical Guidelines, No. 154.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG; 2012 Dec.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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