{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:44:16Z","timestamp":1792680256150,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2015,12,2]],"date-time":"2015-12-02T00:00:00Z","timestamp":1449014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To determine the accuracy of ultrasound in the diagnosis of a tubal ectopic pregnancy in the absence of an obvious extrauterine embryo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a systematic review conducted in accordance with the <jats:styled-content style=\"fixed-case\">PRISMA<\/jats:styled-content> statement and registered with <jats:styled-content style=\"fixed-case\">PROSPERO<\/jats:styled-content>. We searched <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>, <jats:styled-content style=\"fixed-case\">EMBASE<\/jats:styled-content> and The Cochrane Library for relevant citations from database inception to July 2014. Studies were selected in a two\u2010stage process and their data extracted by two reviewers. Accuracy measures were calculated for each ultrasound sign, i.e. empty uterus, pseudosac, adnexal mass and free fluid in the pouch of Douglas, alone and in various combinations. Individual study estimates were plotted in summary receiver\u2013operating characteristics curves and forest plots for examination of heterogeneity. The quality of included studies was assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010one studies including 5858 women were selected from 19\u2009959 citations. Following meta\u2010analysis, an empty uterus on ultrasound was found to predict an ectopic pregnancy with a sensitivity of 81.1% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 42.1\u201396.2%) and specificity of 79.5% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 68.9\u201387.1%). The corresponding performance of the pseudosac, adnexal mass and free fluid were: 5.5% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 3.3\u20139.0%) and 94.2% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 75.9\u201398.8%); 63.5% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 48.5\u201376.3%) and 91.4% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 83.6\u201395.7%); and 47.2% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 33.2\u201361.7%) and 92.3% (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 85.6\u201396.0%), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Visualization of an empty uterus, adnexal mass, free fluid or a pseudosac has poor sensitivity for the diagnosis of a tubal pregnancy when an obvious extrauterine embryo is absent, but it has good specificity. We can therefore infer that ultrasound is more useful for \u2018ruling in\u2019 a tubal pregnancy than \u2018ruling out\u2019 one. However, the findings were limited by the poor quality of some included studies and heterogeneity in the index test and reference standard. Copyright \u00a9 2015 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.14844","type":"journal-article","created":{"date-parts":[[2015,3,12]],"date-time":"2015-03-12T09:23:42Z","timestamp":1426152222000},"page":"28-37","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Accuracy of first\u2010trimester ultrasound in diagnosis of tubal ectopic pregnancy in the absence of an obvious extrauterine embryo: systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"47","author":[{"given":"A.","family":"Richardson","sequence":"first","affiliation":[{"name":"Nurture Fertility The East Midlands Fertility Clinic  Nottingham UK"},{"name":"Division of Child Health, Obstetrics and Gynaecology, School of Medicine University of Nottingham  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Gallos","sequence":"additional","affiliation":[{"name":"School of Clinical and Experimental Medicine, College of Medical and Dental Sciences University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Dobson","sequence":"additional","affiliation":[{"name":"Nottingham University Hospitals NHS Trust Queen's Medical Centre  Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. 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