pregnancy of unknown location

The term pregnancy of unknown location is assigned when neither an intrauterine pregnancy (IUP) or an ectopic pregnancy is identified on transvaginal ultrasound in the context of a positive pregnancy test.

Clinical presentation

• pelvic pain, vaginal bleeding
• positive pregnancy test

Pathology

Markers

• serial beta-hCG: has an adjunct role in the diagnosis of ectopic pregnancy, and is useful in the follow-up of clinically stable patients 
• serum progesterone: lack of progesterone has been considered an indication of nonviability
  • <5 ng/mL is a good indication of nonviability, however, larger values cannot exclude an ectopic pregnancy

Radiographic features

Essentially these patients will present with a "normal" pelvic ultrasound, with no signs of an IUP and normal adnexa .

Treatment and prognosis 

Since the most likely underlying diagnosis is nonviable intrauterine pregnancy, methotrexate and/or surgical intervention are not recommended in a hemodynamically stable patient. Thus, for the hemodynamically stable patient, a short interval repeat ultrasound examination and quantitative beta-hCG level are generally appropriate.

Differential diagnosis

A pregnancy of unknown location basically reflects 4 possibilities:

• very early pregnancy, not yet detected with ultrasound
• nonviable intrauterine pregnancy not detected with ultrasound
• complete miscarriage
• unidentified ectopic pregnancy

See also

• ectopic pregnancy
• early pregnancy

Siehe auch:

• Extrauteringravidität
• Abortus completus

und weiter:

• situs solitus
• pregnancy of uncertain viability