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.
How feasible is expectant management of interstitial ectopic pregnancy?