OC68: The use of serum hCG and progesterone measurement to reduce the need for follow‐up of women with pregnancies of unknown location

Abstract

Objectives: Persisting pregnancy of unknown location (PPUL) remains a controversial clinical problem with no consensus on diagnosis or management. Biochemically, these behave like ectopic pregnancies (EP) or sick intrauterine pregnancies (IUPs). Many clinicians perform laparoscopy with dilatation and curettage (DC 42 (1.3%) of these were diagnosed as PPUL. At initial presentation, the median gestational age was 42 (range, 17–73) days and median initial hCG was 180 (range, 39–1491) IU/mL. Management included laparoscopy in 5/42(12%) women to exclude EP, and two had D&C. No EPs were found at the time of laparoscopy and no chorionic villi discovered at D&C. All 42 women received systemic MTX, with two women requiring two doses. There were no adverse outcomes. Conclusions: PPUL is a diagnosis of exclusion. We define this entity as gestations where the site of pregnancy is never localized on TVS and serum hCG levels plateau on three or more occasions. In the worst-case scenario PPUL can represent ultrasonically missed EPs, but there is little place for laparoscopy or D&C. According to our data, MTX without surgical intervention is the preferred method of treatment.