Should patients who are suspected of having an ectopic pregnancy undergo physical examination?

Objective: To determine whether physical examination is useful for patients with suspected ectopic pregnancy (EP) for whom transvaginal sonography is performed and serum hCG levels are measured. Design: Prospective study. Setting: Two large teaching hospitals. Patient(s): Three hundred eighty-two patients with suspected EP, based on a positive urine pregnancy test and the presence of abdominal pain, vaginal bleeding, or risk indicators. Intervention(s): Abdominal examination, speculum inspection, and digital vaginal examination. Main Outcome Measure: A final diagnosis made by transvaginal sonography, serum hCG measurement, and, if necessary, confirmatory laparoscopy. Result(s): One hundred sixteen (30%) of the 382 patients had an EP. At external abdominal examination, rebound tenderness and muscular rigidity had likelihood ratios of 3.7 and 8.0, respectively. Findings at speculum inspection and digital vaginal examination had likelihood ratios between 0.33 and 2.4. Logistic regression analysis showed that the additional information provided by physical examination for the diagnosis of EP is limited compared with the information provided by transvaginal sonography and serum hCG measurement alone. Conclusion: On the basis of our results, we believe that vaginal digital examination for patients with suspected EP is unnecessary.