Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location

Insogna, Iris G.; Farland, Leslie V.; Missmer, Stacey A.; Ginsburg, Elizabeth S.; Brady, Paula C.

doi:10.1016/j.ajog.2017.04.023

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…One should then perform serum hCG tests immediately before uterine evacuation and 24 hours afterwards. If hCG titers decrease by at least 15% after uterine evacuation, then the diagnosis of a nonviable IUP will follow; on the other hand, if the serum levels of hCG stabilize or increase, then the most likely diagnosis will be EP, and the patient will be treated with MTX because the possibility of incomplete uterine evacuation is unlikely (39,40).…”

Section: Surgerymentioning

confidence: 99%

Pregnancy of unknown location

Pereira

Cabar²,

Gomez

et al. 2019

Clinics

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Pregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists.

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Section: Surgerymentioning

confidence: 99%

Pregnancy of unknown location

Pereira

Cabar²,

Gomez

et al. 2019

Clinics

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“…In women whose β-hCG is highly suspicious of EP, meaning that it does not meet anticipated trend of IUP or spontaneous pregnancy loss, patients may be offered methotrexate or laparoscopy for definitive management. In these patients, office endometrial sampling may represent a good alternative that may obviate the need for these interventions and promote quicker resolution of pregnancy, compared to methotrexate [50]. The presence of chorionic villi is robust evidence of IUP loss, and no further management is recommended.…”

Section: Role Of Endometrial Samplingmentioning

confidence: 99%

Middle-East obgyn graduate education (MOGGE) foundation practice guidelines: diagnostic approach to pregnancy of unknown location: practice guideline no. 03-O-21

Shazly

Radwan

Abdo

et al. 2022

Middle East Fertil Soc J

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Background Pregnancy of unknown location (PUL) is a term used to describe failure of visualization of intrauterine or extrauterine gestational sac in a woman with a positive pregnancy test. Body of the abstract Ectopic pregnancy (EP) accounts for 1–2 % of all pregnancies. EP contributes to maternal mortality of a known cause by 4% in developed countries. However, case fatality rate may be 10 times higher in low-resource countries. This may be attributed to delayed diagnosis and lack of resources. PUL is a temporary term that may eventually lead to diagnosis of viable intrauterine pregnancy, pregnancy loss, or more seriously, EP. Conclusion This guideline appraises current evidence on assessment of PUL and early diagnosis of EP particularly in low-resource settings.

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“…Among all possible outcomes of pregnancy of unknown location, ectopic pregnancy is the most feared outcome. Incidence of ectopic gestation among PUL is about 58% [2] . Late diagnosis might increase the maternal mortality and morbidity, will reduce the success of medical treatment and might require a surgical intervention more frequently, which may further negatively affect fertility of the women.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

B¹,

Vijayarghavan²

2019

Int. J. Clin. Obstet. Gynaecol.

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Background: Pregnancy of unknown location (PUL) is defined as the situation when the urine or serum pregnancy test is positive but there are no signs of intrauterine or extra-uterine pregnancy on ultrasonography and serum beta HCG is in the window period. Among all possible outcomes of pregnancy of unknown location, ectopic pregnancy is the most feared outcome. A delay in diagnosis might increase the maternal mortality and morbidity. Methods: A prospective observational study conducted at Sri Ramachandra Institute of Higher Education and Research, Chennai, between February 2018 and April 2019. Women who had beta HCG in the discriminatory zone with an inconclusive transvaginal ultrasound were included in the study. Serum Creatinine phosphokinase levels were measured along with beta HCG. Results: Among the 12women with PUL, 11 of them were eventually diagnosed with ectopic gestation and one of them remained to be a pregnancy of unknown location. All the patients diagnosed with ectopic gestation had their initial serum CPK levels above the cut off value of 51IU/lit. Conclusion: Serum CPK levels in PUL can be used as a marker for early diagnosis of ectopic gestation when beta HCG and ultrasound are inconclusive. Larger studies are required to ascertain the significance.

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Outpatient endometrial aspiration: an alternative to methotrexate for pregnancy of unknown location

Abstract: With the use of this safe and effective protocol of endometrial aspiration with Karman cannula, a large proportion of women with pregnancy of unknown location are spared methotrexate, with a shorter time to pregnancy resolution than those who receive methotrexate.

Cited by 14 publications

References 23 publications

Pregnancy of unknown location

Pregnancy of unknown location

Middle-East obgyn graduate education (MOGGE) foundation practice guidelines: diagnostic approach to pregnancy of unknown location: practice guideline no. 03-O-21

Pregnancy of unknown location- can serum creatinine phophokinase point towards tubal ectopic gestation?: A pilot study

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