pul

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