title: Utility of dilation and curettage in the diagnosis of pregnancy of unknown location.
abstract: OBJECTIVE
  We sought to determine utility of uterine evacuation for diagnosis of nonviable pregnancy of unknown location (PUL).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Alka
authors.initials: A
authors.lastname: Shaunik
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kulp
authors.forename: Dina H
authors.initials: DH
authors.lastname: Appleby
authors.forename: Mary D
authors.initials: MD
authors.lastname: Sammel
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis*