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Am J Obstet Gynecol. 2011 Feb;204(2):130.e1-6. doi: 10.1016/j.ajog.2010.11.021.

Utility of dilation and curettage in the diagnosis of pregnancy of unknown location.

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  • 1Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Abstract

OBJECTIVE:

We sought to determine utility of uterine evacuation for diagnosis of nonviable pregnancy of unknown location (PUL).

STUDY DESIGN:

We conducted a cohort study to assess the prevalence of ectopic pregnancy (EP), overall, and stratified by presenting signs and symptoms in women with a nonviable PUL.

RESULTS:

Of the 173 women, 66 (38%) had miscarriage (spontaneous abortion [SAB]) and 107 (62%) had EP. When initial human chorionic gonadotropin (hCG) was <2000 mIU/mL, the odds of an EP were greater (odds ratio, 4.32; 95% confidence interval, 2.04-9.12). Demographic factors, obstetric history, and clinical presentation were not useful in distinguishing between EP and SAB. Pre-evacuation hCG increase had strong trend association with EP (odds ratio, 2.14; 95% confidence interval, 0.98-4.68). A >30% fall in postcurettage hCG was suggestive, but was not a diagnostic indicator of SAB.

CONCLUSION:

Uterine evacuation is a useful diagnostic aid for women with nonviable PUL. Nondiagnostic ultrasound findings and absolute and serial hCG values are associated with, but do not accurately predict final diagnosis.

Copyright © 2011. Published by Mosby, Inc.

PMID:
21284966
[PubMed - indexed for MEDLINE]
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