Karine Chung1, Uma Chandavarkar, Neisha Opper, Kurt Barnhart. 1. Division of Reproductive Endocrinology and Infertility, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA.
Abstract
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.
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.
Authors: Katherine E Cameron; Suneeta Senapati; Mary D Sammel; Karine Chung; Peter Takacs; Thomas Molinaro; Kurt T Barnhart Journal: Fertil Steril Date: 2015-12-14 Impact factor: 7.329
Authors: Katherine E Dillon; Vasileios D Sioulas; Mary D Sammel; Karine Chung; Peter Takacs; Alka Shaunik; Kurt T Barnhart Journal: Fertil Steril Date: 2012-07-12 Impact factor: 7.329