[Reevaluating the role of dilation and curettage in the diagnosis of ectopic pregnancy].

Objective: To evaluate the clinical role of dilation and curettage (DC) in the diagnosis of ectopic pregnancy (EP).

Methods: We retrospectively reviewed the clinical data of 108 patients with pregnancy of unknown location who underwent a DC with an abnormal rise in β-human chorionic gonadotropin (β-HCG) level and without visible intrauterine pregnancy (IUP) on transvaginal ultrasound and 24 patients who did not receive DC with β-HCG>5 000 IU/L.The final diagnosis depended on β-HCG trend review after DC and the pathologic and laparoscopic findings.

Results: Overall, 65.3% of the patients were finally diagnosed with EP and 34.7% were found to have a nonviable IUP.Those with EP had significantly higher initial β-HCG than those with nonviable IUP.IUP patients were more likely to have had a history of delivery.Among the patients with β-HCG<2 000 IU/L, 40.0% of EP and 11.0% of IUP had endometrial echo complex no more than 5 mm (P=0.035). In β-HCG<2 000 IU/L and 2 000 IU/L<β-HCG<5 000 IU/L groups, the diagnostic rate of EP was 42.6% and 68.3% respectively (P=0.012). Among the patients with β-HCG>5 000 IU/L, there was no significant difference between those with DC and those without DC (96.7% vs.96%, P=0.915).

Conclusions: Ultrasound findings such as a thin endometrial echo complex and the presence of pelvic mass are associated with but are not diagnostic of an ectopic pregnancy.The patients with the suspected diagnosis of EP are 2 000 IU/L<β-HCG<5 000 IU/L, whereas DC remains important valuable to differentiate EP from nonviable IUP and to avoid misdiagnosis and unnecessary exposure to methotrexate. Because EP is the common final diagnosis in most of the patients with β-HCG>5 000 IU/L and pelvic mass and without intrauterine gestational sac, the value of DC decreases and laparoscopy can be considered directly.