Key Concepts in Pregnancy of Unknown Location: Identifying Ectopic Pregnancy and Providing Patient‐Centered Care

Abstract

Pregnancy of unknown location (PUL) is a descriptive term for when a woman with a positive pregnancy test has a transvaginal ultrasound that cannot determine the site of the pregnancy. While the majority of women with PUL are subsequently diagnosed with a spontaneous abortion or viable intrauterine pregnancy, 7% to 20% of these women have an ectopic pregnancy. The potential for morbidity and mortality related to an ectopic pregnancy means that considerable care is necessary in the evaluation and management of women with PUL. In some cases, the location of the pregnancy is never determined and the PUL is categorized as resolving or persisting. Evidence suggests expectant management is a safe and effective approach for most women with PUL and should be the mainstay of care. However, in the case of persisting PUL, continued concern for ectopic pregnancy remains. Strategies for deciding when to intervene when a woman has a PUL are reviewed. A variety of clinical tools, including serum beta human chorionic gonadotropin (β-hCG), repeat ultrasonography, dilation and curettage (D&C), and empiric methotrexate therapy are discussed. Finally, a proposal is made that women with persisting PUL can be presented with the option of choosing expectant management, diagnostic D&C, or empiric methotrexate treatment.

Randomized trial of the application value of comprehensive nursing intervention in the perioperative period of ruptured bleeding of ectopic pregnancy

“…In addition to correct medical measures, postoperative nursing intervention is also of great significance for the recovery of patients and the improvement of quality of life (11,12). Studies have pointed out that active nursing measures can facilitate successful operation of patients with ruptured bleeding in ectopic pregnancy, and promote clinical efficacy (13).…”

Ectopic Pregnancy with Undetectable Serum Β-Human Chorionic Gonadotropin

“…EP is an important although few frequent gynecological emergency and is a potential cause of morbidity or even mortality in women [5] . While the majority of women with an unknown localizationof pregnancy are subsequently diagnosed with a spontaneous abortion or viable intrauterine pregnancy, almost 10 to 20% of them will have an ectopic pregnancy [6] . Evidence provided by previous studies [7,8] , suggests that expectant management is a safe and effective approach for most women under these clinical situations unless the clinical situation became in an emergency as in our case.…”

Female reproductive health after surgical treatment for acute gynecological diseases

“…Самой распространенной причиной материнской заболеваемости и смертности в I триместре беременности является эктопическая беременность, частота которой в настоящее время составляет 1,2-1,4% от всех беременностей и 0,8-2,4% -от всех родов [11][12][13], по другим данным -от 7 до 20% [14]. Обращает внимание рост частоты внематочной беременности в структуре причин материнской смертности: с 2,1% в 2014 г. до 3,4% в 2015 г.…”

“…Травма яичника ведет к развитию глубоких расстройств иннервации и кровоснабжения органа, гибель части генеративных элементов. В послеоперационном периоде у этих пациенток достоверно часто наблюдается ановуляторный менструальный цикл (41-50%), мультифолликулярный тип яичников (56%), несоответствие структуры эндометрия периовуляторному периоду (43,3-46,3%), нарушения центральной нейровегетативной регуляции (93,8%), снижение кровотока в яичниковой артерии, что служит причиной нарушения не только менструальной (46,3%), но и репродуктивной (31,4%) функций [14,26]. Характерным для большинства оперированных по поводу апоплексии яичников пациенток является возникновение дисфункции гипоталамо-гипофизарно-яичниковой и вегетативной нервных систем, у 52,4-60% пациенток по типу нормогонадотропной нормопролактинемической гипофункции яичников [28][29][30].…”