title: 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).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  None.
  
  
  METHODS
  EP or IUP made by final pathologic review.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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: Division of Reproductive Endocrinology and Infertility, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA 90033, USA.
authors: Karine
authors: K
authors: Chung
authors: Uma
authors: U
authors: Chandavarkar
authors: Neisha
authors: N
authors: Opper
authors: Kurt
authors: K
authors: Barnhart
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D006063:Chorionic Gonadotropin / Q000378:metabolism; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000517:prevention & control*; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D004107:Dilatation and Curettage / Q000379:methods*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate