A study on outcome of pregnancy of unknown location
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20221583Keywords:
PUL, Ectopic pregnancy, Pregnancy of unknown location, Biochemical pregnancy, Transvaginal sonographyAbstract
Background: Pregnancies of unknown location (PUL) are becoming more common as women presenting to early pregnancy assessment units when a pregnancy test comes positive but there is no evidence of an intrauterine pregnancy. The objective of the present retrospective study was to find out the outcome of women with pregnancy of unknown location presenting to a tertiary hospital in Northern Ireland.
Methods: This retrospective analytic study used medical record data between July 2019 and December 2021 from the Altnagelvin Area Hospital of Northern Ireland. TVUS was considered to diagnose the PUL and thereafter beta-human chorionic gonadotrophin (β-hCG) level was monitored as per institutional protocol. Expectant management was carried out until the pregnancy outcome was finalised. Using Statistical package for social sciences (SPSS) version 26, all collected data were analysed using the multinomial logistic regression.
Results: For the analysis among the 63 participants, 25.4% were primi gravida and 38.1% presented with 4-5 weeks of gestation. Pain abdomen and vaginal bleeding was represented by 20.6% and 52.4% respectively. Confirmed ectopic pregnancy was observed among 4.8% and was surgically managed. Also, persistent PUL was 7.9% and these cases were successfully managed by Methotrexate.
Conclusions: The large proportion will be biochemical pregnancy or intrauterine pregnancies, with a tiny fraction of ectopic pregnancies. Early detection of ectopic pregnancy is most challenging part among the women presented with PUL category.
References
Pereira PP, Cabar FR, Gomez ÚT, Francisco RPV. Pregnancy of unknown location. Clinics (Sao Paulo). 2019;74:e1111.
Cordina M, Schramm-Gajraj K, Ross JA, Lautman K, Jurkovic D. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location: a prospective study. BJOG. 2011;118(6):693-7.
Condous G, Timmerman D, Goldstein S, Valentin L, Jurkovic D, Bourne T. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol. 2006;28(2):121-2.
Romero R, Kadar N, Jeanty P, Copel JA, Chervenak FA, DeCherney A, et al. Diagnosis of ectopic pregnancy: Value of the discriminatory human chorionic gonadotropin zone. Obstet Gynecol. 1985;66:357-60.
Condous G, Kirk E, Lu C, Van Huffel S, Gevaert O, De Moor B, et al. Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol. 2005;26:770-5.
Sagili H, Mohamed K. Pregnancy of unknown location: an evidence-based approach to management. Obstet Gynaecol. 2008;10:224-30.
Kirk E, Bottomley C, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update. 2014;20(2):250-61.
Cordina M, Schramm-Gajraj K, Ross JA, Lautman K, Jurkovic D. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location: a prospective study. BJOG. 2011;118(6):693-7.
Kirk E, Papageorghiou AT, Condous G, Tan L, Bora S, Bourne T. The diagnostic effectiveness of an initial transvaginal scan in detecting ectopic pregnancy. Hum Reprod. 2007;22(11):2824-8.
Barnhart K, van Mello NM, Bourne T, Kirk E, Van Calster B, Bottomley C, et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril. 2011;95(3):857-66.
Kadar N, DeVore G, Romero R. Discriminatory hCG zone: its use in the sonographic evaluation for ectopic pregnancy. Obstet Gynecol. 1981;58(2):156-61.
Practice Committee of American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100(3):638-44.
Doubilet PM, Benson CB. Further evidence against the reliability of the human chorionic gonadotropin discriminatory level. J Ultrasound Med. 2011;30(12):1637-42.
Connolly A, Ryan DH, Stuebe AM, Wolfe HM. Reevaluation of discriminatory and threshold levels for serum β-hCG in early pregnancy. Obstet Gynecol. 2013;121(1):65-70.
Ko JK, Cheung VY. Time to revisit the human chorionic gonadotropin discriminatory level in the management of pregnancy of unknown location. J Ultrasound Med. 2014;33(3):465-71.
Bottomley C, VanBelle V, Mukri F, Kirk E, VanHuffel S, Timmerman D, et al. The optimal timing of an ultrasound scan to assess the location and viability of an early pregnancy. Hum Reprod. 2009;24:1811-7.
Hahlin M, Thorburn J, Bryman I. The expectant management of early pregnancies of uncertain site. Hum Reprod. 1995;10:1223-7.
Banerjee S, Aslam N, Zosmer N, Woelfer B, Jurkovic D. The expectant management of women with early pregnancy of unknown location. Ultrasound Obstet Gynecol. 1999;14:231-6.
Pereira PP, Cabar FR, Gomez ÚT, Francisco RPV. Pregnancy of unknown location. Clinics (Sao Paulo). 2019;74:e1111.
