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. 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

Alka Shaunik  1 , Jennifer Kulp, Dina H Appleby, Mary D Sammel, Kurt T Barnhart
Affiliations

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

Alka Shaunik et al. Am J Obstet Gynecol. 2011 Feb.

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.

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