Predicting Outcomes in Pregnancies of Unknown Location

Emma Kirk; Tom Bourne

Disclosures

Women's Health. 2008;4(5):491-499. 

In This Article

Uterine Curettage

One commonly used algorithm to diagnose ectopic pregnancy is based on the use of pelvic ultrasound to demonstrate the absence of an intrauterine sac followed by uterine curettage, after a viable pregnancy has been excluded either by a low serum progesterone level or on the basis of a suboptimal rise in hCG over 48h.[25,26] According to this protocol, if the hCG level fails to decrease by more than 15% or increases 8-12h after curettage, a diagnosis of ectopic pregnancy is assumed. This approach does have pitfalls as it may lead to intervention in some viable intrauterine pregnancies. A study investigating 1003 PULs has shown that criteria established for the use of uterine curettage in the management of PULs, including those advocated by the American Society for Reproductive Medicine (ASRM), could theoretically result in inadvertent termination of an ongoing IUP.[27] Uterine curettage should, therefore, not have a routine place in the management of PULs and the diagnosis of ectopic pregnancy. However, it may play a role in diagnosing the location of failing PULs, but it should not be used until the possibility of a viable pregnancy has been eliminated.

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