Pregnancy of Unknown Location: A Survey-Based Evaluation of When and Why Physicians Intervene?

Abstract

Management of pregnancies of unknown location (PUL) is a complex challenging clinical situation with possibilities for pitfalls. Obstetricians and gynaecologists of varied levels of training and experience from Canada and the Nordic countries were questioned about their approach when faced with PUL. A 13-item web-based questionnaire was used to evaluate physicians' behaviors by surveying their management of a PUL encountered at different levels of human chorionic gonadotropin (hCG). They were queried regarding the level of hCG at which they would take management action in an asymptomatic PUL, in a given scenario. Three hundred fifty three questionnaires were completed resulting in a response rate, representing completeness of the survey, of 78.6%. Three distinct hCG thresholds, at which intervention to interrupt a PUL would be considered, dominated the responses. Thirty seven percent of physicians would intervene at hCG levels between 1000-3000 IU, 22% selected the 4000-6000 IU range, and 13% would only intervene if the hCG level exceeded 10000 IU. These ranges were similar across different levels of clinical experience. In addition to hCG values, a patient's desire to keep the pregnancy, the development of new symptoms, and the expected gestational age were the other principal factors influencing the decision to intervene. There appears to be little consensus regarding the hCG threshold at which medical intervention should be initiated in an asymptomatic pregnancy of unknown location and further studies to justify earlier or later intervention are needed to determine the appropriate time for intervention.