Accuracy of the Direct Laparoscopic Diagnosis for Suspected Ectopic Pregnancy without a Diagnostic Uterine Curettage

Abstract

Objective: Whether a diagnostic uterine dilatation and curettage [D&C] is necessary in cases of suspected ectopic pregnancy [EP] remains controversial. Some reports insist that a D&C is mandatory because the inaccuracy of presumed diagnoses of EP is quite high. Other reports claim that a D&C is redundant because the patient must undergo anesthesia and surgery twice if the final diagnosis is EP. At our institute, direct laparoscopic inspection without a D&C is employed in patients with suspected EP. We evaluated the accuracy of this method and the characteristics of misdiagnosed cases.Design: Retrospective cohort analysis.Methods: We performed a retrospective review of our gynecologic database of patients with suspected EP between 1994 and 2006. The total number of patients was 350. One hundred thirty-four patients who underwent a diagnostic D&C or a laparotomy were excluded and the final number of patients examined was 216. The patients were classified into 4 subgroups: group A, definite EP (an ectopic fetal heart movement [FHM] was detected by ultrasound [US] ) ; group B, suspected EP with abdominal pain and abnormal findings other than an ectopic FHM by US; group C, suspected EP with pain, but no US findings; and group D, suspected EP without pain, but with abnormal US findings. The outcome was determined using the pathologic evidence of the surgical specimen.Results: Twelve patients did not have an EP, and the overall inaccuracy rate of diagnosis was 5.6%. When examined according to subgroups, the inaccuracy rates were 3.3% (1/30), 4.1% (6/144), 16.7% (1/6), and 11.1% (4/36) in groups A-D, respectively. One case in group A diagnosed as an interstitial pregnancy was revealed to be an intrauterine pregnancy [IUP] . The final diagnosis of 1 case in group B was ovarian bleeding, but the US findings led to a misdiagnosis in the other cases. All of the misdiagnosed cases in groups C and D were revealed to be IUPs.Conclusion: Conclusion: The direct laparoscopic diagnosis of EP is reasonable in definite or suspected cases with both abdominal pain and abnormal US findings because this necessitates anesthesia and surgery to be performed one time only. A D&C should be considered in cases with either pain or abnormal US findings.