Pregnancies of unknown location after in vitro fertilization minimally invasive management with Karman cannula aspiration

Capsule:
Outpatient management of pregnancies of unknown location using endometrial sampling with a Karman cannula aspiration can obviate the need for methotrexate.

Authors:
Paula Brady, M.D., Anthony N. Imudia, M.D., Awoniyi Awonuga, M.D., Diane L. Wright, Ph.D., Aaron K. Styer, M.D., Thomas L. Toth, M.D.

Volume 101, Issue 2, Pages 420-426, February 2014

Abstract:

Objective:
To describe a standardized protocol for the assessment of asymptomatic patients with pregnancies of unknown location (PUL) after IVF.

Design:
Retrospective cohort study.

Setting:
University-based infertility clinic.

Patient(s):
Women undergoing fresh IVF/intracytoplasmic sperm injection (ICSI) cycles between 2005 and 2011.

Intervention(s):
Endometrial sampling using Karman suction cannula in patients with PUL and abnormal β-hCG trend (increase <53% or decrease <15% in 2 days) and a pelvic ultrasound unremarkable for an intrauterine pregnancy (IUP) or an ectopic pregnancy (EP). Main Outcome Measure(s):
Proportion of patients spared methotrexate (MTX) administration.

Result(s):
Endometrial sampling was performed in 45 patients. Of these, 31 (68.9%) were diagnosed with failed IUP by either a sampling after the β-hCG decline (≥15%) and/or the presence of villi on final pathology. No further intervention was required. Fourteen patients (31.1%) were diagnosed with presumed EP by persistent β-hCG level after negative pathology. Ten of these patients (71%) were successfully treated with a single dose of MTX; three required an additional dose, and one required laparoscopy for a ruptured EP.

Conclusion(s):
In asymptomatic patients with PUL and abnormal β-hCG trends after IVF, the utility of Karman aspiration to confirm an IUP may obviate treatment with MTX in more than two-thirds of patients.

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