Normal intrauterine pregnancy is unlikely in patients who have echogenic material identified within the endometrial cavity at transvaginal ultrasonography

In first-trimester patients with abdominal pain or vaginal bleeding, pelvic ultrasonography (US) is often performed to assess the status of the pregnancy. Identification of echogenic material within the endometrial cavity in the absence of a gestational sac has been attributed to the presence of either retained products of conception or clotted blood. However, to the authors' knowledge, no study has directly addressed whether this finding reliably excludes the diagnosis of a normal intrauterine pregnancy (TUP). Objective: To determine whether the identification of echogenic material within the endometrial cavity at transvaginal US excludes the diagnosis of a normal IUP. Methods: Data were collected retrospectively from August 1991 to August 1997 on consecutive urban teaching hospital ED patients with abdominal pain or vaginal bleeding who had a transvaginal US performed during the ED visit; that demonstrated echogenic material within the endometrial cavity. Patients were excluded if they had a dilatation and evacuation (D+E) procedure performed prior to the exclusion of a normal IUP by other means [open cervical os, falling quantitative beta-human chorionic gonadotropin (beta-hCG) values, a progesterone value <5.0 ng/mL or beta-hCG >3,000 mIU/mL] or if they were lost to follow-up. Patients were followed until a final diagnosis was ultimately determined. Results: A total of 83 patients with echogenic material were identified. Of these, three patients were excluded because a D+E was performed prior to an IUP being excluded by other means, and two patients were lost to followup. Of the 78 enrolled patients, none had a final diagnosis of normal IUP. Ectopic pregnancy was confirmed in nine patients, five of whom had no adnexal or cul de sac findings to suggest this diagnosis. Conclusion: In symptomatic patients who have echogenic material but no gestational sac visualized within the endometrial cavity at US, the likelihood of a normal IUP is low.