Diagnosing ectopic pregnancy using Bayes theorem: a retrospective cohort study.

OBJECTIVE: To verify the accuracy of an online algorithm using Bayes' theorem for diagnosing ectopic pregnancy (EP) using human chorionic gonadotropin (hCG), ultrasound, and clinical data in a real cohort. DESIGN: A retrospective cohort study. SETTING: Gynecologic emergency unit in a tertiary teaching hospital. PATIENT(S): First-trimester pregnant women who attended the gynecologic emergency unit for any reason. Those who had <13 weeks of pregnancy confirmed by a recent positive pregnancy test; a digital image or electronic report of transvaginal ultrasound (TVUS) obtained from hospital database; and a follow-up with a pathology report or a clinical resolution of a confirmed pregnancy were included in the study. Clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels were independent variables obtained from the electronic medical records. From these data, the pretest probability, based on the clinical presentation and risk factors, and the likelihood ratio for each variable were calculated for their use in the algorithm, yielding a posttest probability. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): The accuracy of the online algorithm to identify cases of EP using clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels. The main outcome was EP, confirmed either by pathology report or by the presence of fetal heartbeat or gestational sac outside the uterine cavity. RESULT(S): Between January 1, 2009 and December 27, 2016, 2,495 women were analyzed, and the algorithm was applied to 2,185 of them. The incidence of EP was 8.5% (212/2,495); 310 women were excluded because they were submitted to surgery with decision thresholds <95%. The algorithm was applied to 2,185 women. Just one case remained inconclusive after 3 consultations, and it was considered as an error in prediction. The sensitivity, specificity, and accuracy values (95% confidence interval) of the algorithm were 98.9% (96.1%-99.8%), 98.9% (98.3%-99.2%), and 98.9% (98.3%-99.2%), respectively. CONCLUSION(S): The accuracy of the Bayesian algorithm to confirm or rule out EP is excellent. Online Nomogram https://docs.google.com/spreadsheets/d/1jStXlMBjbPyDf6_W0deKGKQLZHU5EFAe8rLhNVPuJuY/edit?usp=sharing.

Prevalence of Chlamydia trachomatis in Women Who Are Candidates for In Vitro Fertilization in a Private Reference Service in Southern Brazil: A Cross-Sectional Study.

Introduction Chlamydia trachomatis (CT) has been related to fallopian tube damage and infertility. Its prevalence in the population that attend public services is known; however, there is scant data on this factor in private infertility clinics. The objective of this study is to verify the prevalence of CT among women attending a private in vitro fertilization (IVF) reference clinic in southern Brazil. Methods This is a cross-sectional study carried out between January 1, 2019, and August 30, 2021, at an IVF private clinic in southern Brazil. Infertile women between 18 and 50 years old, who provided a morning urinary sample for reverse transcription-polymerase chain reaction (RT-PCR) test for CT analysis, were included in the study. The variables studied included the patient's age, body mass index (BMI), duration of infertility, type of infertility, indication for IVF, and detection or not of CT in the urine. Results The prevalence of CT was 10.84% (22 out of 203; 95% CI: 7.27-15.87). Patients with secondary infertility were older and had more ovarian and tubal factors compared to cases of primary infertility. The tubal factor was the most prevalent (27.3% in women with primary infertility and 35.8% in those with secondary). Time of infertility and BMI were similar between groups. Our results are derived from a single private IVF clinic which reduces the external validity. Conclusion The prevalence of 10.84% of CT in this population raises the importance of screening for sexually transmitted infections for proper treatment and to achieve better IVF outcomes.

Avaliaçäo dos critérios utilizados na interpretaçäo da histerossalpingografia em esterilidade conjugal / Evaluation of the criteria used for hysterosalpingographic interpretation in sterile couples

Este trabalho foi realizado com o objetivo de comparar os achados da histerossalpingografia (HSG) na rotina da esterilidade conjugal, quando realizada por radiologistas que avaliavam apenas a permeabilidade tubária e por radiologistas que avaliavam, além dessa, outros fatores de comprometimento tubário. Foram estudadas 100 pacientes que consultaram a Fundaçao Universitária de Endocrinologia e Fertilidade. Os achados histerossalpingográficos foram comparados aos achados de laparoscopias diagnósticas (LD). Os serviços de radiologia foram divididos em dois grupos: A - quando o único critério de avaliaçao era a permeabilidade ou nao das trompas; B - quando, além desse, outros critérios como dilataçoes, fimoses, enovelamentos, dificuldade de escoamento, etc. eram avaliados e descritos no laudo radiológico. A concordância global entre os dois métodos (HSG e LD) ocorreu, somente, em 51 casos (51 por cento). Entretanto, nas pacientes do primeiro grupo (47 casos), houve concordância em apenas sete casos (14,89 por cento); de outro modo, no segundo grupo (53 casos), a concordância foi de 44 casos (83,1 por cento). Conclui-se, portanto, que o critério único de permeabilidade das trompas nao traduz com fidelidade o estado de patologia tubária, induzindo o clínico a um diagnóstico incorreto de higidez tubária com sérias implicaçoes no prognóstico e na terapêutica a ser instituída.