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.
Outcome of 100(54.6%) patients was failing pregnancy of unknown location, 58(31.7%) had intrauterine pregnancy, 14(7.7%) converted to ectopic pregnancy, while 11(6%) had persistent pregnancy of unknown location.
Conclusions: Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management.
Keywords: Pregnancy of unknown location, PUL, Ectopic pregnancy, Methotrexate, Saudi Arabia, Assir region.
Pregnancy of unknown location (PUL) is a descriptive term used for a woman who has positive pregnancy test, but no pregnancy can be visualised on transvaginal ultrasonography (TVS).1 Incidence of PUL is 8-10% but some studies have reported incidence of 8-31%.2 PUL has four possible outcomes; a) Intrauterine pregnancy (IUP), b) Failing PUL (F-PUL), c) Ectopic pregnancy (EP), and d) Persistent PUL (P-PUL).3 Most common outcome is an F-PUL (44-69%) and 7-20% will subsequently be diagnosed with EP.
"Our data demonstrate that using a single value of serum hCG in a pregnancy of unknown location (PUL) population is of limited value....
There is limited risk in taking a few extra days to make a definitive diagnosis in a woman with a pregnancy of unknown location who has no signs or symptoms of rupture and no ultrasonographic evidence of ectopic pregnancy."
"Viable intrauterine pregnancy is possible in patients with pregnancy of unknown location and hCG levels above the generally accept discriminatory zone, strict adherence to which can potentially disrupt a normal pregnancy.