Use of the endometrial pipelle in the diagnosis of early abnormal gestations

Objective: To determine the sensitivity and specificity of the endometrial pipelle (Unimar, Wilton, CT) in detecting intrauterine chorionic villi, as compared to standard suction dilation and curettage (D and C). Design: Prospective clinical study. Setting: U. S. Navy Hospital near Tokyo, Japan. Small community hospital. Patient(s): All patients presenting for the surgical management of an early abnormal gestation were enrolled prospectively. The patient's age, gravidy , parity, estimated gestational age (EGA), diagnosis, preoperative beta hum an chorionic gonadotropin (beta hCG) level, and preoperative transvaginal u ltrasound (TVUS) data were recorded. Intervention(s): An endometrial biopsy was performed in the operating room prior to standard suction dilatation and curettage (D and C). Main Outcome Measure(s): The presence of chorionic villi in the endometrial biopsy and curettage specimens were recorded for each patient. Result(s): The sensitivity of the endometrial pipelle in detecting intraute rine chorionic villi was 63% and the specificity was 80%. Conclusion(s): In the diagnosis of an early abnormal gestation, particularl y in excluding an ectopic pregnancy, it would be ideal to replace the more invasive D and C with the outpatient endometrial biopsy in detecting intrau terine chorionic villi. However, the limited sensitivity of the endometrial biopsy limits its application in this clinical scenario. Our results compa re with two previous studies and add to the limited patient database on thi s topic. (Fertil Steril(R) 2000;74:593-5. (C) 2000 by American Society for Reproductive Medicine.).