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.
Induction of labour at 41 weeks of gestation versus expectant management and induction of labour at 42 weeks of gestation: a cost‐effectiveness analysis
