Dilatation and Curettage

Uterine curettage provides a method for the definitive diagnosis of an IUP when chorionic villi are obtained from the uterine cavity. EP is thus excluded unless a heterotopic (combined) pregnancy is present. The procedure can be performed in a outpatient setting with intravenous sedation. The procedure terminates an IUP if present and is thus applicable only when termination of pregnancy is desired or when a nonviable pregnancy has been documented. A progesterone level of £5 ng/mL or stable or falling bhCG levels provide good though not certain evidence of nonviability. The specimen obtained at D&C is examined for the presence of chorionic villi. This may be done at the bedside by suspending the specimen in saline. Villi are observed to float, and absence of material that floats is presumptive evidence of absent villi and thus suggestive of an EP. One study reported a 6.6 percent; false-negative rate (i.e., villi were reported as present in cases later proved to be EP) with this method and there are false-positive tests as well. The results should thus be interpreted cautiously and formal histologic exam of the specimen is needed in addition to bedside suspension of the specimen.

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