Active vs Expectant Management of Persisting Pregnancy of Unknown Location—Reply

JAMA ◽  
2021 ◽  
Vol 326 (22) ◽  
pp. 2330
Author(s):  
Kurt T. Barnhart ◽  
Anne Z. Steiner ◽  
Karl R. Hansen
Keyword(s):  
Expectant Management ◽  
Pregnancy Of Unknown Location

Role of Serum β-HCG doubling in Diagnosis of Early Pregnancy and its Management Strategy

2020 ◽  
Vol 16 ◽  
Author(s):  
Divya Mirji ◽  
Shubha Rao ◽  
Akhila Vasudeva ◽  
Roopa P.S
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Management Strategy ◽  
Transvaginal Ultrasound ◽  
Expectant Management ◽  
First Trimester ◽  
Intrauterine Pregnancy ◽  
Β Hcg ◽  
Pregnancy Of Unknown Location

Background: Pregnancy of unknown location (PUL) is defined as the absence of intrauterine or extrauterine sac and Beta Human Chorionic Gonadotropin levels (β-HCG) above the discriminatory zone of 1500 mIU/ml. It should be noted that PUL is not always an ectopic; however, by measuring the trends of serum β-HCG, we can determine the outcome of a PUL. Objective: This study aims to identify the various trends β-HCG levels in early pregnancy and evaluate the role of β-HCG in the management strategy. Methods: We conducted a prospective observational study of pregnant women suspected with early pregnancy. Cases were classified as having a pregnancy of unknown location (PUL) by transvaginal ultrasound and ß-HCG greater than 1000 mIU/ml. Expectant management was done until there was a definite outcome. All the collected data were analyzed by employing the chi-square test using SPSS version 20. Results: Among 1200 women who had early first trimester scans, 70 women who fulfilled our criteria of PUL and ß-HCG > 1000 mIU/ml were recruited in this study. In our study, the mean age of the participants was 30±5.6yrs, and the overall mean serum ß-HCG was 3030±522 mIU/ml. The most common outcome observed was an ectopic pregnancy, 47% in our study. We also found the rate of failing pregnancy was 27%, and that of intrauterine pregnancy (IUP) was 25%. Overall, in PUL patients diagnosed with ectopic pregnancy, 9% behaved like IUP, and 4% had an atypical trend in their ß-HCG. Those who had an IUP, 11% had a suboptimal increase in ß-HCG. Conclusion: PUL rate in our unit was 6%. Majority of the outcome of PUL was ectopic in our study. Every case of PUL should be managed based on the initial ß-HCG values, clinical assessments and upon the consent of the patient.

scholarly journals Methotrexate or expectant management in women with an ectopic pregnancy or pregnancy of unknown location and low serum hCG concentrations? A randomized comparison

2012 ◽  
Vol 28 (1) ◽  
pp. 60-67 ◽  
Author(s):  
N. M. van Mello ◽  
F. Mol ◽  
H. R. Verhoeve ◽  
M. van Wely ◽  
A. H. Adriaanse ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Expectant Management ◽  
Pregnancy Of Unknown Location ◽  
Low Serum

scholarly journals Effect of an Active vs Expectant Management Strategy on Successful Resolution of Pregnancy Among Patients With a Persisting Pregnancy of Unknown Location

JAMA ◽  
2021 ◽  
Vol 326 (5) ◽  
pp. 390
Author(s):  
Kurt T. Barnhart ◽  
Karl R. Hansen ◽  
Mary D. Stephenson ◽  
Rebecca Usadi ◽  
Anne Z. Steiner ◽  
...  
Keyword(s):  
Management Strategy ◽  
Expectant Management ◽  
Successful Resolution ◽  
Pregnancy Of Unknown Location

scholarly journals Pregnancy of unknown location: outcome in a tertiary care teaching hospital

2017 ◽  
Vol 6 (7) ◽  
pp. 2787
Author(s):  
A. Shanti Sri ◽  
P. Kalpana
Keyword(s):  
Ectopic Pregnancy ◽  
Early Pregnancy ◽  
Tertiary Care ◽  
Expectant Management ◽  
Transvaginal Sonography ◽  
Intrauterine Pregnancy ◽  
Care Teaching ◽  
Asymptomatic Patients ◽  
Pain Outcome ◽  
Pregnancy Of Unknown Location

Background: A pregnancy of unknown location (PUL) is a descriptive term used to classify a woman when she has a positive pregnancy test but no intra- or extra-uterine pregnancy is visualized on transvaginal sonography. The objective of present study was to find out the outcome of women with pregnancy of unknown location presenting to a tertiary care teaching hospital.Methods: The prospective study was conducted from from 1st October 2015 to 31st September 2016, to antenatal out-patient department, at Princess Esra Hospital, Deccan College of medical sciences, Hyderabad. Data was collected for women with early pregnancy or with history of amenorrhea, bleeding or pain. These women were investigated with serum beta-human chorionic gonadotrophin levels at interval of 48 hrs and transvaginal ultrasonography. Expectant management was done for failing pregnancy of unknown location while medical or surgical management was considered for persistent pregnancy of unknown location and ectopic pregnancy.Results: During study period, 9210 patients were admitted, and, of them, 960 (10.42%) were patients with early pregnancy. Meeting the inclusion criteria were 112 (11.6%) patients who formed the study sample. There were 104 (92.85%) patients presenting with amenorrhea, 98 (87.5%) had bleeding and 78 (69.64%) presented with pain. Outcome of 42 (48.83%) patients was failing pregnancy, 31 (36.04%) had intrauterine pregnancy, 8 (9.3%) converted to ectopic pregnancy, while 5 (5.81%) had persistent pregnancy of unknown location. All patients with persistent pregnancy of unknown location and 3 patients with ectopic pregnancy were medically treated. Three patients having an ectopic pregnancy were managed surgically.Conclusions: Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management. Most of the patients suspected to have PUL resolved either into F-PUL or IUP with expectant management.

Active vs Expectant Management of Persisting Pregnancy of Unknown Location

JAMA ◽  
2021 ◽  
Vol 326 (22) ◽  
pp. 2329
Author(s):  
Jian-Rong He ◽  
Hui-Yun Xiao ◽  
Xiu Qiu
Keyword(s):  
Expectant Management ◽  
Pregnancy Of Unknown Location

scholarly journals The expectant management of women with early pregnancy of unknown location

1999 ◽  
Vol 14 (4) ◽  
pp. 231-236 ◽  
Author(s):  
S. Banerjee ◽  
N. Aslam ◽  
N. Zosmer ◽  
B. Woelfer ◽  
D. Jurkovic
Keyword(s):  
Early Pregnancy ◽  
Expectant Management ◽  
Pregnancy Of Unknown Location

scholarly journals P067: Ectopic pregnancy outcomes in patients discharged from the emergency department

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S80-S81
Author(s):  
K. Hawrylyshyn ◽  
S. McLeod ◽  
J. Thomas ◽  
C. Varner
Keyword(s):  
Ectopic Pregnancy ◽  
Chart Review ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Expectant Management ◽  
Retrospective Chart Review ◽  
Missed Abortion ◽  
Ectopic Pregnancies ◽  
Pregnancy Of Unknown Location ◽  
Rule Out

Introduction: The objective of this study was to determine the proportion of women who had a ruptured ectopic pregnancy after being discharged from the ED where ectopic pregnancy had not yet been excluded. Methods: This was a retrospective chart review of pregnant (<12 week gestational age) women discharged home from an academic tertiary care ED with a diagnosis of ectopic pregnancy, rule out ectopic pregnancy, or pregnancy of unknown location (PUL) over a 7 year period. Results: Of the 550 included patients, 83 (15.1%) had a viable pregnancy, 94 (17.1%) had a spontaneous or missed abortion, 230 (41.8%) had an ectopic pregnancy, 72 (13.1%) had unknown outcomes and 71 (12.9%) had other outcomes which included therapeutic abortion, molar pregnancy or resolution of HCG with no location documented. Of the 230 ectopic pregnancies, 42 (7.6%) underwent expectant management, 131 (23.8%) were managed medically with methotrexate, 29 (5.3%) were managed with surgical intervention, and 28 (5.1%) patients had a ruptured ectopic pregnancy after their index ED visit. Of the 550 included patients, 221 (40.2%) did not have a transvaginal US during their index ED visit, 73 (33.0%) were subsequently diagnosed with an ectopic pregnancy. Conclusion: These results may be useful for ED physicians counselling women with symptomatic early pregnancies about the risk of ectopic pregnancy after they are discharged from the ED.

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