Hysterosalpingography and selective salpingography in the differential diagnosis of chemical intrauterine versus tubal pregnancy.

OBJECTIVE

To determine the validity of hystersalpingography (HSG) and/or bilateral selective salpingography in the differential diagnosis of early (biochemical) intrauterine versus intratubal abortions.

DESIGN

The study design involved the performance of HSG and selective salpingography in sequential patients with low declining beta-human chorionic gonadotropin (beta-hCG) values.

SETTING

Medical School-affiliated Infertility Center.

PARTICIPANTS

Four sequential pregnant infertility patients who demonstrated declining beta-hCG levels before pregnancy could be confirmed by ultrasound (chemical pregnancies).

RESULTS

Three of four patients demonstrated a characteristic tubal opacification pattern in conjunction with a normally appearing endometrial cavity, considered diagnostic of an early tubal pregnancy. In contrast, a missed intrauterine pregnancy (IUP) demonstrated a characteristically abnormal endometrial cavity.

CONCLUSIONS

Some early (chemical) pregnancy losses are intratubal rather than intrauterine. The correct differential diagnosis of early missed IUPs versus intratubal pregnancies is important because of its prognostic significance.