Idiopathic spontaneous haemoperitoneum at 4 weeks gestation

A 20-year-old nulliparous patient with acute-onset abdominal pain and imaging suggestive of haemoperitoneum was admitted for observation. Though, initially, haemodynamically stable, her clinical picture worsened throughout her hospitalisation and warranted two separate laparoscopies that revealed 1200 mL and 50 mL of haemoperitoneum, respectively, without an identifiable bleeding source. After serial β-human chorionic gonadotropin levels and ultrasound confirmation of a viable pregnancy 23 days later, the patient underwent a normal antenatal course and delivered a healthy infant at 37 weeks gestation. This unusual case highlights the need to consider spontaneous haemoperitoneum in pregnancy as a diagnosis, particularly in the setting of pregnancy of unknown location, even at an early stage of pregnancy.

Protocols for prediction of ectopic pregnancy in pregnancy of unknown location：a systematic review and meta-analysis

Background: The ectopic pregnancy(EP) patients requires the closely monitor. However, there is no international consensus through which method to select EP patients from the pregnancy of unknown location (PUL) patients. Objective: To summarize and review the protocols of screening patients with EP when being diagnosed with PUL. Search strategy: We searched MEDLINE, web of science and Embase from inception to May 2020. All the articles were dual-reviewed based on predetermined selection criteria. Selection criteria: Studies exploring PUL outcomes can be included. Data collection and analysis: Prediction results, final diagnosis, and expense depending on patient’s visits and examination were analyzed by R. version 3.6.3 and Revman version 5.4. Results: 29 studies were included. M6 model had the areas under the curve(AUC) of 0.944, the progesterone cut-offs an AUC of 0.725, and the M4 model an AUC of 0.871 respectively. When the sum of visits and examinations of the protocols increased from 3 to 5, the rate of lost to follow-up patients increased from 11.19% to 18.63%. The average production utility of progesterone cut-offs is 0.242, the M4 is 0.174, and the M6 is 0.157. Conclusions: The M6 model had the best performance to predict EP among the PUL patients. The progesterone cut-offs is the most cost-effective method to predict the final outcome of EP. Fundings: Project supported by National Natural Science Foundation of China (82073323) and the Joint Funds of the National Natural Science Foundation of China (U20A20368). Keywords: ectopic pregnancy, pregnancy of unknown location, predictive protocol，hCG，progesterone.