Dataset Information

External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.

ABSTRACT:

Objective

To validate externally 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 2 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 (10%) women who were lost to follow up. The area under the ROC curve for EP was 0.89 (95% CI 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 for prediction and triage in PUL.

Tweetable abstract

The M6 model, as part of a two-step triage strategy, is the best approach to characterise and triage PULs.

SUBMITTER: Christodoulou E

PROVIDER: S-EPMC7821217 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.

Christodoulou E E Bobdiwala S S Kyriacou C C Farren J J Mitchell-Jones N N Ayim F F Chohan B B Abughazza O O Guruwadahyarhalli B B Al-Memar M M Guha S S Vathanan V V Gould D D Stalder C C Wynants L L Timmerman D D Bourne T T Van Calster B B

BJOG : an international journal of obstetrics and gynaecology 20201007 3

<h4>Objective</h4>To validate externally 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).<h4>Design</h4>Secondary analysis of a prospective cohort study.<h4>Setting</h4>Eight UK early pregnancy assessment units.<h4>Population</h4>Women presenting with a PUL and BhCG >25 IU/l.<h4>Meth ...[more]

PMID: 32931087

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Dataset Information

External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusions

Tweetable abstract

Publications

External validation of models to predict the outcome of pregnancies of unknown location: a multicentre cohort study.

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