Pregnancy - Tubal Ectopic and Pregnancies of unknown location – Diagnosis and Management

Transvaginal sonography (TVS) is now the imaging modality of choice for the diagnosis of ectopic pregnancy with overall reported sensitivities of > 90%. Specific sonographic criteria exist for the diagnosis of tubal and non-tubal pregnancies including cervical and caesarean section scar pregnancies. Diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intra-uterine pregnancy. A "pregnancy of unknown location" (PUL) is a descriptive term used to classify a pregnancy when a woman has a positive pregnancy test, but no pregnancy can be visualised on transvaginal ultrasound (TVS). Women should be followed until the final pregnancy outcome is known which includes: failing PUL, intra-uterine pregnancy, ectopic pregnancy and persisting PUL. Expectant management has been shown to be safe and surgical intervention in the form of uterine curettage and diagnostic laparoscopy should not be undertaken routinely. Serum human chorionic gonadotrophin levels, progesterone levels and mathematical models all have a role in the prediction of PUL outcome. This lecture discusses the various aspects of management of women with an ectopic pregnancy and PUL.

A/Prof George Condous from Omni Gynaecological Care.

Supported by Bayer Schering