Curettage (Nạo) — The intrauterine location of a pregnancy is diagnosed with certainty if trophoblastic tissue is obtained by uterine curettage (nạo buồng tử cung) Obviously, the use of curettage as a diagnostic tool is limited by the potential for disruption of a viable pregnancy Moreover, false negatives (dương tính giả) can occur: chorionic villi (gai nhau) are not detected by histopathology (giải phẫu bệnh) in 20 percent of curettage specimens (mẫu mô nạo) from elective termination of pregnancy Pipelle endometrial biopsy (sinh thiết nội mạc tử cung ống hút) is even less sensitive than curettage for detection of villi; sensitivities reported in two small series were 30 and 60 percent If curettage is performed, serum hCG levels can be followed post-curettage if histopathology does not confirm the clinical impression When an IUP has been evacuated, hCG levels should drop by at least 15 percent the day after evacuation Some experts have recommended performing curettage only on women with both a hCG concentration below the discriminatory zone and a low doubling rate Approximately 30 percent of these patients have a nonviable intrauterine gestation and the remainder have an ectopic pregnancy Knowing the results of curettage avoids unnecessary methotrexate treatment of the 30 percent of patients without ectopic pregnancy A decision analysis comparing the cost/complication rates in patients who undergo diagnostic curettage before administration of methotrexate with those who not have a curettage concluded there was no significant benefit of one approach over the other However, the authors' preference was to perform curettage in these patients to be more certain of the diagnosis, and felt this information was useful prognostically (eg, risk of recurrence) and for future decisionmaking In contrast, we and others believe it is more practical and less invasive to continue observation or administer one dose of methotrexate than to perform curettage The side effects of one dose of methotrexate are negligible In addition, curettage carries a risk of intrauterine adhesion formation Other tests — Rarely, laparoscopy (nội soi ổ bụng) is used to confirm the diagnosis if hCG and ultrasound results are ambiguous An ectopic pregnancy detected at laparoscopy should be treated immediately by surgery In this situation, a medical approach confers additional risk and has no proven benefit Historically, culdocentesis (chọc dò túi sau) was used to detect blood in the posterior culde-sac; however, this finding can be easily demonstrated with transvaginal ultrasound Blood in the posterior cul-de-sac may be from bleeding from an unruptured or ruptured tubal pregnancy, but it may also be the result of a ruptured ovarian cyst Therefore, a culdocentesis positive for blood is nondiagnostic Additional testing — Additional testing is performed to evaluate the patient’s hemodynamic status, Rh(D) type (hệ Rh) If methotrexate treatment is a possibility, pretreatment laboratory tests should be drawn Complete blood count — Women with suspected ectopic pregnancy should be evaluated for anemia with a hemoglobin and/or hematocrit In severe cases, if heavy bleeding (chảy máu nhiều) is suspected, measurement of platelets or coagulation tests may also be indicated If ectopic pregnancy is diagnosed and treatment with methotrexate is considered, a complete blood count is part of the pretreatment laboratory evaluation Blood type and screen — A Rh(D) typing and antibody screen should be drawn if not previously performed during the current pregnancy Women with bleeding in pregnancy who are Rh(D)negative should be given anti-D immune globulin If significant bleeding is suspected, a sample should be sent to the blood bank for crossmatching for potential transfusion Pretreatment laboratory tests — For women treated with methotrexate, pretreatment testing typically includes a complete blood count and renal and liver function tests DIAGNOSIS — The diagnosis of ectopic pregnancy is a clinical diagnosis made based upon serial serum human chorionic gonadotropin (hCG) testing and transvaginal ultrasound (TVUS) Histologic confirmation of the diagnosis is not typically required In selected cases, uterine curettage is performed to confirm the absence of an intrauterine pregnancy (IUP) prior to methotrexate therapy If an ectopic pregnancy is treated surgically, histologic confirmation is obtained following treatment ... curettage is performed to confirm the absence of an intrauterine pregnancy (IUP) prior to methotrexate therapy If an ectopic pregnancy is treated surgically, histologic confirmation is obtained... nhiều) is suspected, measurement of platelets or coagulation tests may also be indicated If ectopic pregnancy is diagnosed and treatment with methotrexate is considered, a complete blood count... antibody screen should be drawn if not previously performed during the current pregnancy Women with bleeding in pregnancy who are Rh(D)negative should be given anti-D immune globulin If significant