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Is there a need to definitively diagnose the location of a pregnancy of unknown location? The case for "no".
MedLine Citation:
PMID:  23084010     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The ability to predict the outcome of a pregnancy of unknown location (PUL) has been extensively studied over the past decade. Between 8%-14% of PULs will develop into ectopic pregnancies (EP), and therefore the need to confirm pregnancy location is not without good reason. Strategies to predict EP in the PUL population have included the use of various maternal serum biomarkers and repeat transvaginal ultrasound (TVS) examinations in order to avoid delaying this diagnosis. These follow-up tests are associated with substantial financial cost to the healthcare system, as well as impacting on maternal anxiety. However, the majority of women with a PUL at follow-up will either have an intra-uterine pregnancy or a spontaneously resolving PUL, and therefore represent low-risk PULs. Most of these low-risk PULs do not need intervention and expectant management has been shown to be safe and not associated with adverse outcomes. Therefore we need consider whether the current strategies to determine pregnancy location are indeed essential for women with a PUL, especially when balancing the additional health care burden with the potential increase in maternal morbidity/mortality associated with delay in diagnosis. This beckons the question, "Do we really need to definitively diagnose pregnancy location in women with a PUL?
Authors:
Shannon Reid; George Condous
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Fertility and sterility     Volume:  98     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1085-90     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Affiliation:
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia. Electronic address: sereid@gmail.com.
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