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

Shaunik, Alka; Kulp, Jennifer L.; Appleby, Dina; Sammel, Mary D.; Barnhart, Kurt T.

doi:10.1016/j.ajog.2010.11.021

Cited by 44 publications

(33 citation statements)

References 9 publications

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“…Identification of villi on endometrial sampling is diagnostic of a failed IUP, and in such cases, no further treatment is usually needed [5, 114, 115]. Serum β-hCG should also be checked the day after endometrial sampling; a decline of 15–20 % after sampling indicates the disruption of a failing IUP, even if no villi are identified [5].…”

Section: Reviewmentioning

confidence: 99%

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Panelli

Phillips

Brady

2015

Fertil Res and Pract

207

251

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BackgroundEctopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar.FindingsDiagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality.ConclusionThis review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.

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Section: Reviewmentioning

confidence: 99%

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Panelli

Phillips

Brady

2015

Fertil Res and Pract

207

251

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“…It has been repeatedly demonstrated that up to 50% of women with a high hCG value and no evidence of an intrauterine pregnancy on ultrasound have an intrauterine gestation, not an ectopic pregnancy. 19–21 …”

Section: Risk Of Treatment Of An Intrauterine Pregnancymentioning

confidence: 99%

Medical Management of Ectopic Pregnancy

Bachman¹,

Barnhart²

2012

Clinical Obstetrics &Amp; Gynecology

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Medical management has become increasingly popular in the treatment of ectopic pregnancy. Given its convenience, for many it is used as a first line treatment, but this is not always the optimal choice for the patient. It is important to understand the options for medical treatment and when it is appropriate to treat a particular patient with medical management, or when one should opt for surgical management. This review outlines the different regimens for methotrexate administration and the associated risks and benefits to medical management.

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“…A vigorous debate has emerged in the literature concerning the optimal management strategy of a nonviable PUL with regard to the administration of methotrexate for a presumed ectopic pregnancy or uterine curettage to definitively locate the pregnancy [7-9, 11]. Treatment strategies in this clinical conundrum are yet to be compared with randomized clinical trials; however, it has been found that preferences still exist.…”

Section: Introductionmentioning

confidence: 99%

“…However, 10–20% of transvaginal ultrasounds performed in symptomatic pregnant women early in the first trimester are nondiagnostic, leading to the classification of a pregnancy of unknown location (PUL) [1, 6]. While up to 50–70% of PUL resolve spontaneously without treatment, 7–20% of PUL are diagnosed as ectopic pregnancy [2, 7, 8]. …”

Section: Introductionmentioning

confidence: 99%

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

Parks

Barnhart

Howard

2018

Gynecol Obstet Invest

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Background: When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL. Methods: A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States. Results: A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians. Conclusions: Based on our findings, there does not appear to be a consensus regarding the management of a PUL.

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

Cited by 44 publications

References 9 publications

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review

Medical Management of Ectopic Pregnancy

Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States

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