The utility of a dilatation and evacuation procedure in patients with symptoms suggestive of ectopic pregnancy and indeterminate transvaginal ultrasonography

Objectives: To ascertain the overall frequency of obtaining chorionic villi (CV) in patients with indeterminate transvaginal ultrasound (US) examinati ons who have had a dilatation and evacuation (D+E) procedure performed, to determine whether the frequency of obtaining CV is dependent on whether the endometrial cavity is empty at US, and to determine the likelihood of ecto pic pregnancy in patients without CV after D+E and with or without an empty endometrial cavity at US. Methods: A retrospective review was made of cons ecutive ED patients presenting to an urban teaching hospital from August 19 91 through August 1997 with abdominal pain or vaginal bleeding and a positi ve beta-human chorionic gonatropin (beta-hCG) test. Patients who had a tran svaginal US that was read as indeterminate (no extrauterine findings of ect opic pregnancy, and no intrauterine fetal pole or yolk sac) and who had a D +E performed within 48 hours of the ED visit were eligible. US exams were s ubdivided into two groups, those with empty endometrial cavities and those with endometrial cavities that contained fluid, echogenic material, or sac- like structures. The presence or absence of CV was based on the official pa thology report. Patients were excluded if pathology results were not availa ble. Results: A total of 255 patients met eligibility criteria. Of these, p athology results were not available for five patients. Of the remaining pat ients, 177 of 250 (70.8%: 95% CI = 64.7% to 76.3%) had CV identified in the pathology specimen. The difference in the frequencies of obtaining CV in t hose with empty endometrial cavities (35/78; 44.9%: 95% CI = 34% to 56%) vs those without empty endometrial cavities (142/172; 82.6%: 95% CI = 76% to 88%) was significant (p < 0.001), Ectopic pregnancy was diagnosed in 17 of 42 (40.0%) with empty uteri at US and no CV at pathology vs 5 of 26 (19.2%) in whom the uterus was not empty and no CV were obtained (p = 0.07). Concl usion: In symptomatic patients with indeterminate transvaginal ultrasound e xams, CV will be identified after D+E in approximately 70% of cases. Althou gh CV were found with increased frequency when the endometrial cavity was n ot empty, still almost half of the patients with empty uteri had villi iden tified. Finally, although the frequency of ectopic pregnancy was higher in the patients with empty uteri and no CV at D+E, vs those without an empty u terus and no CV, this difference did not reach statistical significance.