Reevaluating the role of dilation and curettage in the diagnosis of pregnancy of unknown location

• Published in: Fertility and sterility Vol. 96; no. 3; pp. 659 - 662
• Main Authors: Chung, Karine, M.D., M.S.C.E, Chandavarkar, Uma, M.D, Opper, Neisha, M.P.H, Barnhart, Kurt, M.D., M.S.C.E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2011; Elsevier
• Subjects: Abortifacient Agents, Nonsteroidal - therapeutic use; Adolescent; Adult; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Chorionic Gonadotropin - metabolism; Cohort Studies; Diagnostic Errors - prevention & control; Diagnostic Techniques, Obstetrical and Gynecological; Dilatation and Curettage - methods; dilation and curettage; Diseases of mother, fetus and pregnancy; Ectopic pregnancy; endometrium; Female; Gynecology. Andrology. Obstetrics; human chorionic gonadotropin; Humans; Internal Medicine; Medical sciences; methotrexate; Methotrexate - therapeutic use; Middle Aged; Obstetrics and Gynecology; patients; Pharmacology. Drug treatments; Pregnancy; pregnancy diagnosis; Pregnancy, Ectopic - diagnosis; Pregnancy, Ectopic - diagnostic imaging; Pregnancy, Ectopic - metabolism; Pregnancy. Fetus. Placenta; Retrospective Studies; ultrasonics; Ultrasonography; women; Young Adult; Ectopic pregnancy; methotrexate; dilation and curettage; Antineoplastic agent; Pregnancy disorders; Gynecology; Obstetrics; Antifolate; Curettage; Antimetabolic; Dilatation; Antirheumatic agent; Diagnosis; Methotrexate
• DOI: 10.1016/j.fertnstert.2011.06.017
• ISSN: 0015-0282

Objective To evaluate the clinical utility of dilation and curettage (D&C) in diagnosing ectopic pregnancy (EP). Design Retrospective cohort study. Setting University hospital. Patient(s) Clinically stable women (n = 321) who underwent a diagnostic D&C with no visible intrauterine pregnancy (IUP) on transvaginal ultrasound or those with an abnormal hCG trend. Intervention(s) None. Main Outcome Measure(s) EP or IUP made by final pathologic review. Result(s) Overall, 73.2% of the patients were ultimately diagnosed with EP and 26.8% were found to have a nonviable IUP. Those with EPs had significantly lower initial hCGs than those with nonviable IUPs and were more likely to have had a history of an EP. On ultrasound, the overall impression, the presence of free fluid, and the endometrial echo complex correlated well with the final diagnoses but did not have 100% predictive value. Conclusion(s) D&C remains valuable to differentiate EP from nonviable IUP and to avoid misdiagnosis and unnecessary exposure to methotrexate. Low initial hCG values and ultrasound findings such as a thin endometrial echo complex and the presence of free fluid are associated with but are not diagnostic of an ectopic pregnancy.