Factors to consider in pregnancy of unknown location

Shabnam Bobdiwala, Maya Al-Memar, Jessica Farren, Tom Bourne, Shabnam Bobdiwala, Maya Al-Memar, Jessica Farren, Tom Bourne

Abstract

The management of women with a pregnancy of unknown location (PUL) can vary significantly and often lacks a clear evidence base. Intensive follow-up is usually required for women with a final outcome of an ectopic pregnancy. This, however, only accounts for a small proportion of women with a pregnancy of unknown PUL location. There remains a clear clinical need to rationalize the follow-up of PUL so women at high risk of having a final outcome of an ectopic pregnancy are followed up more intensively and those PUL at low risk of having an ectopic pregnancy have their follow-up streamlined. This review covers the main management strategies published in the current literature and aims to give clinicians an overview of the most up-to-date evidence that they can take away into their everyday clinical practice when caring for women with a PUL.

Keywords: ectopic pregnancy; human chorionic gonadotropin; pregnancy; pregnancy of unknown location; progesterone; risk prediction models.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Figures

Figure 1.
Figure 1.
Schematic for PUL classification at the initial transvaginal ultrasound scan.
Figure 2.
Figure 2.
Schematic for PUL classification to define the final outcome.
Figure 3.
Figure 3.
hCG ratio cut-off values and the likely final outcomes with a PUL. hCG: human chorionic gonadotropin; PUL: pregnancy of unknown location; IUP: intrauterine pregnancy.
Figure 4.
Figure 4.
Flowchart of final outcome data and correct versus incorrect risk stratification by the M4 model. Source: Taken from Bobdiwala et al. hCG: human chorionic gonadotropin; FPUL: failed pregnancy of unknown location; IUP: intrauterine pregnancy; EP: ectopic pregnancy.
Figure 5.
Figure 5.
Flow diagram of the two-step approach for managing PUL. Source: Taken from Van Calster et al. hCG: human chorionic gonadotropin; UPT: urine pregnancy test; PUL: pregnancy of unknown location.

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