Clinical Verification And Application In Discriminant Equation Pregnancy Of Unknown Location

Objective:Pregnancy of unknown location (PUL) refers to the symptoms that with positive pregnancy tests, gestational women’s intrauterine gestational sac cannot be found by ultrasound examination during their first preganant4to6weeks-a period which is probably to be diagnosed as ectopic pregnancy stage. The incidence of the symptoms is8%to31%. Ectopic pregnancy is one of the most common causes resulting in acute abdomen and death in obstetrics and gynecology. Due to lack of early diagnosis of sensitivity index, EP has been regarded as a high risk of early pregnancy complications. PUL is one of the most common causes of EP, with the incidence of12.4%to43.5%. Moreover, tubal preghancy is the main symptom of EP-the rate of occurrence is more than98%-which should be paid close attention to. dilation and curettage or laparoscopy cannot be operated for the patients of PUL, especially for those who has a desire for birth, which brings difficulty to clinical differential diagnosis and makes medical personnel helpless. From the above statement, to discover a non-invasive, quick method of identifying PUL with perfect authenticity, reliability and prediction, which can facilitate large-scale clinical application, has become a focus of modern medical research.Methods:Based on SongYang’s PUL discriminant equation, the study has developed a software used in Windows operating system platform. With the way of prospective study, the author has collected qualified inpatients’clinical data corresponding to the equation variables, including:the duration of Cessation of menstruation (XI), irregular vaginal bleeding (X2), regular menstruation (X3), history of spontaneous abortion (X4), history of EP (X5), history of pelvic inflammatory disease (X6), placed intrauterine device (X7), the initial progesterone value (X8), abdominal pain (X9), the initial HCG value (XIO), ultrasound examination for the Uteri ne ateral block (XI1), pelvic cavity accumulates fluid(X12). The12related variables are generated into PUL discriminant equation software to discriminate tubal preghancy or threatened abortion. Meanwhile, the target patients’final diagnosis will be tracked and compared with discriminant diagnosis, in order to observe the similarities and dissimilarities between the two diagnoses. For comprehensive evaluation of the value of the clinical application of this equation, the author will draw conclusions from the collected data, analyze the collected data by relevan statistical methods and carry out inspection of validity (Sensitivity, Specificity, false negative rate, false positive rate, positive likelihood ratio, negative likelihood ratio, Youden’s index), inspection of reliability (agreement rate, Kappa Value) and inspection of predictive value(positive predictive value, negative predictive value).Result:The study has included327effective cases. The average duration of Cessation of menstruation is40.7309+5.85831days.(1)According to discriminant equation,229cases had been diagnosed as early stage tubal preghancy,98cases early threatened abortion; and217cases were finally diagnosed as early stage tubal preghancy,110cases early threatened abortion. Among the cases,215patients were accurately discriminated as early stage tubal preghancy,14cases are erroneous.96cases are accurately discriminated as early threatened abortion,2cases are erroneous.(2) Average progesterone T test shows the no significant differences of accurate diagnoses between the group of early stage tubal preghancy and that of early threatened abortion.(3) The investigation of the equation’s validity shows:sensitivity:99.08%, specificity:87.27%, false negative rate:0.92%, false positive rate:12.73%, positive likelihood ratio:7.78, negative likelihood ratio:0.01, Youden’ s index:0.8635. The reliable inspection shows:rate of coincidence:95.11%, Kappa value:0.8874. the research of predictive value shows:positive predictive value:93.89%, negative predictive value:97.96%.Conclusion:Discriminant equation OF PUL has higher detection rates of early tubal pregnancy in diagnoses of pregnancy of unknown location discrimination. The equation has high accuracy and sound predictive value for the diagnoses of early tubal pregnancy and early threatened abortion. The above evidence proves that this equation is a perfect identification method used in clinical application, as a relatively ideal non-invasive, quick approach with reasonable validity, reliability and predictive value.