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Protocols for prediction of ectopic pregnancy in pregnancy of unknown location：a systematic review and meta-analysis

Background: The ectopic pregnancy(EP) patients requires the closely
monitor. However, there is no international consensus through which
method to select EP patients from the pregnancy of unknown location
(PUL) patients. Objective: To summarize and review the protocols of
screening patients with EP when being diagnosed with PUL. Search
strategy: We searched MEDLINE, web of science and Embase from inception
to May 2020. All the articles were dual-reviewed based on predetermined
selection criteria. Selection criteria: Studies exploring PUL outcomes
can be included. Data collection and analysis: Prediction results, final
diagnosis, and expense depending on patient’s visits and examination
were analyzed by R. version 3.6.3 and Revman version 5.4. Results: 29
studies were included. M6 model had the areas under the curve(AUC) of
0.944, the progesterone cut-offs an AUC of 0.725, and the M4 model an
AUC of 0.871 respectively. When the sum of visits and examinations of
the protocols increased from 3 to 5, the rate of lost to follow-up
patients increased from 11.19% to 18.63%. The average production
utility of progesterone cut-offs is 0.242, the M4 is 0.174, and the M6
is 0.157. Conclusions: The M6 model had the best performance to predict
EP among the PUL patients. The progesterone cut-offs is the most
cost-effective method to predict the final outcome of EP. Fundings:
Project supported by National Natural Science Foundation of China
(82073323) and the Joint Funds of the National Natural Science
Foundation of China (U20A20368). Keywords: ectopic pregnancy, pregnancy
of unknown location, predictive protocol，hCG，progesterone.