Abstract
Objective
Our objective was to measure the sensitivity and specificity of a six-item “pregnancy
checklist” at excluding early- or luteal-phase pregnancy among women with a negative
urine pregnancy test who were initiating contraception.
Study design
This was a secondary analysis of the Contraceptive CHOICE Project, a prospective cohort
study of 9256 women in the St. Louis region. Women who had a negative urine pregnancy
test on the day of enrollment were included in this analysis. Women with a positive
urine pregnancy test or without urine pregnancy testing were excluded. We identified
all luteal-phase pregnancies that occurred among women with a negative urine pregnancy
test. We calculated the sensitivity, specificity, positive predictive value and negative
predictive value (NPV) and likelihood ratios of the pregnancy checklist for excluding
luteal-phase pregnancies.
Results
There were 6929 women included in this analysis; 69% of these women met at least one
checklist criterion to exclude pregnancy (“negative screen”). There were 36 luteal-phase
pregnancies (0.5%) subsequently diagnosed among women with a negative urine pregnancy
test. The sensitivity and specificity of the checklist were 77.7% and 69.1%, respectively.
The NPV of the checklist was 99.8% and the positive predictive value was 1.3%.
Conclusion
Among women with a negative urine pregnancy test, the pregnancy checklist can be used
to safely exclude more than 99% of early pregnancies at the time of contraceptive
initiation.
Implications
In patients with a negative urine pregnancy test, a pregnancy checklist using six
criteria based on patient history has high NPV in excluding early pregnancy. This
checklist can be used to facilitate same-day initiation of contraceptive methods,
including long-acting reversible contraception. Although the checklist had a high
false positive rate, initiation of contraception should not be delayed in women with
a “positive screen.” Rather women who desire an intrauterine device or implant can
be “bridged” with a shorter-acting method until pregnancy can be excluded.
Keywords
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Article info
Publication history
Published online: August 07, 2014
Accepted:
August 3,
2014
Received in revised form:
July 30,
2014
Received:
February 20,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
