First-trimester ultrasound: is a single-visit strategy in pregnancies of unknown location safe?

Abstract

Objective: The aim of this study was to evaluate the safety and feasibility of a single-visit approach to pregnancies of unknown location (PUL).Methods: All PUL had serum HCG and PROG measured at presentation and 48 hours (hrs). All women were followed until a diagnosis was established: failing pregnancy, intrauterine pregnancy (IUP), or ectopic pregnancy (EP). We then retrospectively tested the need for a second visit based upon the first blood result only. Two groups could be eliminated from the system (i.e., not necessary to have either a second transvaginal scan [TVS] or a second blood test). Those with resolving pregnancies (PROG ≤ 20 nmol/L and HCG > 25 IU/L) and those with ongoing pregnancies (PROG > 60 nmol/L and HCG ≤ 1000 IU/L). These are defined as the non-ectopic PUL group. Two groups of patients would need a second visit to the hospital. Those with a high risk for EP (PROG 20–60 nmol/L and HCG > 25 IU/L) would need a repeat TVS and a blood test at 48 hrs and those with an EP (PROG > 60 nmol/L and HCG > 1000 IU/L) would undergo laparoscopy. These are defined as the ectopic PUL group.Results: 352 PUL: 192 (54.55%) failing PUL, 128 (36.36%) IUP, and 32 (9.09%) EP. The sensitivity and specificity of a second visit to detect EP were 50% and 68.75%, respectively (see Table 1). The positive predictive and negative predictive values of a second visit were 13.79% and 93.22%, respectively (see Table 1). Of the 68 classified as high risk for ectopic PUL, 53 (77.9%) were not non-ectopic PUL, i.e., failing or intrauterine pregnancies. Of the 20 classified as ectopic PUL, 19 (95%) were non-ectopic PUL.Conclusions: Single-visit management of PUL is unsafe, with 50% of ectopics being discharged with no follow-up. A single-visit strategy should not be used as an alternative to the current two-visit strategy.Tabled 1DiagnosisNeed for 2nd Visit NoNeed for 2nd Visit YesNon-ectopic PUL220100Ectopic PUL1616 Open table in a new tab Objective: The aim of this study was to evaluate the safety and feasibility of a single-visit approach to pregnancies of unknown location (PUL). Methods: All PUL had serum HCG and PROG measured at presentation and 48 hours (hrs). All women were followed until a diagnosis was established: failing pregnancy, intrauterine pregnancy (IUP), or ectopic pregnancy (EP). We then retrospectively tested the need for a second visit based upon the first blood result only. Two groups could be eliminated from the system (i.e., not necessary to have either a second transvaginal scan [TVS] or a second blood test). Those with resolving pregnancies (PROG ≤ 20 nmol/L and HCG > 25 IU/L) and those with ongoing pregnancies (PROG > 60 nmol/L and HCG ≤ 1000 IU/L). These are defined as the non-ectopic PUL group. Two groups of patients would need a second visit to the hospital. Those with a high risk for EP (PROG 20–60 nmol/L and HCG > 25 IU/L) would need a repeat TVS and a blood test at 48 hrs and those with an EP (PROG > 60 nmol/L and HCG > 1000 IU/L) would undergo laparoscopy. These are defined as the ectopic PUL group. Results: 352 PUL: 192 (54.55%) failing PUL, 128 (36.36%) IUP, and 32 (9.09%) EP. The sensitivity and specificity of a second visit to detect EP were 50% and 68.75%, respectively (see Table 1). The positive predictive and negative predictive values of a second visit were 13.79% and 93.22%, respectively (see Table 1). Of the 68 classified as high risk for ectopic PUL, 53 (77.9%) were not non-ectopic PUL, i.e., failing or intrauterine pregnancies. Of the 20 classified as ectopic PUL, 19 (95%) were non-ectopic PUL. Conclusions: Single-visit management of PUL is unsafe, with 50% of ectopics being discharged with no follow-up. A single-visit strategy should not be used as an alternative to the current two-visit strategy. Tabled 1DiagnosisNeed for 2nd Visit NoNeed for 2nd Visit YesNon-ectopic PUL220100Ectopic PUL1616 Open table in a new tab