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DOI: 10.1055/s-0038-1676123
Pregnancy of Unknown Location: The Value of Frozen Section Analysis and Its Relation to Beta-hCG Levels and Endometrial Thickness
Publikationsverlauf
12. Juli 2018
09. Oktober 2018
Publikationsdatum:
12. Dezember 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00030576/201903/lookinside/thumbnails/10-1055-s-0038-1676123_180233-1.jpg)
Abstract
Objective Frozen section examination is a rapid method for identifying products of conception in endometrial curetting, yet its accuracy is inconclusive. The purposes of this study is to determine the accuracy of frozen section analysis of endometrial curetting in pregnancies of unknown location, and to verify the relation of β-human chorionic gonadotrophin (hCG) level and endometrial thickness to the assessed accuracy.
Methods We reviewed data from January 2009 to December 2014 of diagnostic curettages from women with suspected ectopic pregnancies sent for frozen section examination at a medical center. A frozen section diagnosis was considered accurate if it concurred with the final pathologic diagnosis.
Results Of 106 frozen section studies, the diagnosis was accurate in 94 (88.7%). Of 79 specimens interpreted as negative on frozen sections (no products of conception noted), 9 (11.4%) were positive on final pathologic review. Three of the 27 (11.1%) specimens interpreted as positive by a frozen section failed to demonstrate products of conception on a final pathologic section. The sensitivity of frozen sections in the diagnosis of ectopic pregnancy was 72.7%, specificity 95.9%, positive predictive value 88.9%, negative predictive value 88.6%, and accuracy 88.6%. A statically significant correlation was found between β-hCG level and high accuracy of the frozen section technique (p < 0.001). No correlation was found between endometrial thickness and the accuracy of the frozen section technique.
Conclusion The accuracy of frozen section examination was high and was found to correlate with β-hCG level, but not with endometrial thickness.
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References
- 1 Lipscomb GH, Stovall TG, Ling FW. Nonsurgical treatment of ectopic pregnancy. N Engl J Med 2000; 343 (18) 1325-1329 Doi: 56/NEJM200011023431807
- 2 Aboulghar MA, Mansour RT, Serour GI. Transvaginal injection of potassium chloride and methotrexate for the treatment of tubal pregnancy with a live fetus. Hum Reprod 1990; 5 (07) 887-888 Doi: 10.1093/oxfordjournals.humrep.a137204
- 3 Altaras M, Cohen I, Cordoba M, Ben-Nun I, Ben-Aderet N. Treatment of an interstitial pregnancy with actinomycin D. Case report. Br J Obstet Gynaecol 1988; 95 (12) 1321-1323 Doi: 10.1111/j.1471-0528.1988.tb06826.x
- 4 Gazvani MR, Emery SJ. Mifepristone and methotrexate: the combination for medical treatment of ectopic pregnancy. Am J Obstet Gynecol 1999; 180 (6 Pt 1): 1599-1600 Doi: 10.1016/S0002-9378(99)70067-0
- 5 Kenigsberg D, Porte J, Hull M, Spitz IM. Medical treatment of residual ectopic pregnancy: RU 486 and methotrexate. Fertil Steril 1987; 47 (04) 702-703 Doi: 10.1016/S0015-0282(16)59126-2
- 6 Lindblom B, Hahlin M, Lundorff P, Thorburn J. Treatment of tubal pregnancy by laparoscope-guided injection of prostaglandin F2 alpha. Fertil Steril 1990; 54 (03) 404-408 Doi: 10.1016/S0015-0282(16)53752-2
- 7 Lang PF, Weiss PA, Mayer HO, Haas JG, Hönigl W. Conservative treatment of ectopic pregnancy with local injection of hyperosmolar glucose solution or prostaglandin-F2 alpha: a prospective randomised study. Lancet 1990; 336 (8707): 78-81 Doi: 10.1016/0140-6736(90)91593-Y
- 8 Barnhart K, Mennuti MT, Benjamin I, Jacobson S, Goodman D, Coutifaris C. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol 1994; 84 (06) 1010-1015
- 9 Spandorfer SD, Menzin AW, Barnhart KT, LiVolsi VA, Pfeifer SM. Efficacy of frozen-section evaluation of uterine curettings in the diagnosis of ectopic pregnancy. Am J Obstet Gynecol 1996; 175 (3 Pt 1): 603-605 Doi: 10.1053/ob.1996.v175.a73599
- 10 Barak S, Oettinger M, Perri A, Cohen HI, Barenboym R, Ophir E. Frozen section examination of endometrial curettings in the diagnosis of ectopic pregnancy. Acta Obstet Gynecol Scand 2005; 84 (01) 43-47 Doi: 10.1111/j.0001-6349.2005.00531.x
- 11 Heller DS, Hessami S, Cracchiolo B, Skurnick JH. Reliability of frozen section of uterine curettings in evaluation of possible ectopic pregnancy. J Am Assoc Gynecol Laparosc 2000; 7 (04) 519-522 Doi: 10.1016/S1074-3804(05)60366-0
- 12 Condous G, Timmerman D, Goldstein S, Valentin L, Jurkovic D, Bourne T. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol 2006; 28 (02) 121-122 Doi: 10.1002/uog.2838
- 13 Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol 1981; 58 (02) 156-161
- 14 Goldstein SR, Snyder JR, Watson C, Danon M. Very early pregnancy detection with endovaginal ultrasound. Obstet Gynecol 1988; 72 (02) 200-204
- 15 Timor-Tritsch IE, Rottem S, Thaler I. Review of transvaginal ultrasonography: a description with clinical application. Ultrasound Q 1988; 6: 1-34
- 16 Bernaschek G, Rudelstorfer R, Csaicsich P. Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy. Am J Obstet Gynecol 1988; 158 (3 Pt 1): 608-612
- 17 Peisner DB, Timor-Tritsch IE. The discriminatory zone of beta-hCG for vaginal probes. J Clin Ultrasound 1990; 18 (04) 280-285 Doi: 10.1002/jcu.1870180411
- 18 Barnhart K, van Mello NM, Bourne T. , et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril 2011; 95 (03) 857-866 Doi: 10.1016/j.fertnstert.2010.09.006
- 19 Seeber BE, Sammel MD, Guo W, Zhou L, Hummel A, Barnhart KT. Application of redefined human chorionic gonadotropin curves for the diagnosis of women at risk for ectopic pregnancy. Fertil Steril 2006; 86 (02) 454-459 Doi: 10.1016/j.fertnstert.2005.12.056
- 20 Verhaegen J, Gallos ID, van Mello NM. , et al. Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies. BMJ 2012; 345: e6077 Doi: 10.1136/bmj.e6077
- 21 Condous G, Kirk E, Lu C. , et al. There is no role for uterine curettage in the contemporary diagnostic workup of women with a pregnancy of unknown location. Hum Reprod 2006; 21 (10) 2706-2710 Doi: 10.1093/humrep/del223