Uterine Curettage Versus Presumptive Methotrexate for Non-Viable Pregnancy of Unknown Location [33H]

Abstract

INTRODUCTION: When managing a non-viable pregnancy of unknown location (PUL), it is unknown which factors influence the decision to perform a uterine curettage versus presumptive administration of methotrexate. METHODS: A prospective, anonymous electronic survey of PUL case scenarios was administered to physicians registered with the American Medical Association Physician Masterfile and to all Obstetrics and Gynecology residents and academic faculty located in the United States. RESULTS: A total of 214 physicians responded. When presented with a patient diagnosed with a PUL by transvaginal ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable pregnancy, 78 (37.0%) would offer uterine curettage before administrating methotrexate while 67 (31.7%) would offer methotrexate presumptively. The odds of choosing uterine curettage was more than four-fold higher among academic physicians compared to resident physicians (adjusted OR 4.05, 95% CI 1.62-10.10). There was no difference between private practice physicians and resident physicians. Compared to physicians in the Northeast, physicians in the South were much more likely to select uterine curettage as their initial management strategy (adjusted OR 2.48, 95% CI 0.99-6.20). CONCLUSION: Resident physicians appear to be significantly more likely to presumptively administer methotrexate compared to academic physicians in the context of a non-viable PUL. If confirmed by larger studies, this finding has direct implications for future resident education.