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

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.