Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
Abstract
Pregnancy of Unknown Location (PUL) is a diagnostic challenge in early pregnancy, where initial ultrasonography fails to locate the pregnancy despite a positive pregnancy test. Managing PUL is essential to promptly identify ectopic pregnancies while avoiding unnecessary interventions in cases that may resolve spontaneously. This study aims to evaluate diagnostic approaches, management strategies and clinical outcomes in women diagnosed with PUL in a tertiary care setting. This retrospective cohort study analyzed 15 women diagnosed with PUL from January 2022 to December 2023 at a tertiary care center. Data on patient demographics, clinical presentation, diagnostic modalities (serial β‐hCG and transvaginal ultrasound) and management approaches were collected. Outcomes included resolution of PUL, confirmation of intrauterine or ectopic pregnancy and any complications. Statistical analysis was conducted to identify factors predictive of ectopic pregnancy. The mean age of participants was 30 years, with 67% presenting symptomatically. Initial diagnostic evaluation included transvaginal ultrasound and serial β‐hCG measurements in all cases, while laparoscopy was utilized in 20% of cases with inconclusive imaging. Expectant management was successful in 83% of selected cases, while Methotrexate resolved 80% of medically managed cases. Surgical intervention was required for confirmed ectopic pregnancies (27%). Factors predictive of ectopic pregnancy included initial β‐hCG levels >1500 IU/L, absence of a gestational sac and presence of pelvic free fluid (p<0.05). Overall, 33% of PUL cases resolved spontaneously, 33% were confirmed ectopic pregnancies and 20% progressed to confirmed intrauterine pregnancies. This study demonstrates the utility of a structured approach combining serial β‐hCG and transvaginal ultrasound in managing PUL. Expectant management is effective in cases with lowrisk factors, while high‐risk features should prompt closer monitoring and potential intervention. Identifying predictive factors for ectopic pregnancy helps optimize patient outcomes and reduce unnecessary interventions in PUL cases.
How to cite this article:
Binusha J. Ashok and Rema V. Nair. Diagnosis and Management of Pregnancy of Unknown Location: A Retrospective Cohort Study in a Tertiary Care Center.
DOI: https://doi.org/10.36478/makrjms.2024.12.988.992
URL: https://www.makhillpublications.co/view-article/1815-9346/makrjms.2024.12.988.992