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- W2002539056 abstract "To evaluate the pregnancy of unknown location (PUL) protocol in an EPAU in a district general hospital. A retrospective case note analysis for the first six months from introduction of the PUL protocol. The protocol is based on an expectant approach using serum hCG and progesterone levels, after Banerjee et al, 2001. Notes were reviewed for all patients having a positive pregnancy test and no pregnancy located on transvaginal ultrasound scan (TVS). All initial ultrasounds were carried out by sonographers. For each case, clinical details, scan findings, initial levels of hCG and progesterone, subsequent investigations, management, and outcomes were recorded. These were compared to the departmental protocol. A total of 74 PULs were identified and the protocol applied giving a PUL rate of 8.8%. 7 PULs were not identified as PULS and the protocol was not applied. In 7 cases the PUL protocol was applied despite evidence of a pregnancy on TVS. 41% (30/74) of cases were managed correctly in accordance to the protocol. 3 cases resulted in unexpected outcomes (2 progesterone < 20 nmol/l needed salpingectomy, 1 progesterone > 60 nmol/l resulted in a failed PUL) 6 cases where correct diagnosis missed on initial TVS (4 IUPs hCG > 1000 IU/l, 2 large ectopic pregnancies identified by consultant TVS within next 24 hours). We have demonstrated that the PUL rate was comparable with the literature despite a lower level of TVS expertise than used in previous studies. The PUL protocol appears to be safe and effective with a sensitivity of 86% and a specificity of 92%. There was only a 4% surgical intervention rate. The only case of tubal rupture was one of the large ectopic pregnancies with an hCG of 8956 IU/l missed on initial scan. The main areas identified for improvement are TVS expertise and education regarding correct application of and adherence to the protocol." @default.
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- W2002539056 date "2006-08-31" @default.
- W2002539056 modified "2023-10-04" @default.
- W2002539056 title "OC65: Does a pregnancy of unknown location protocol work in a district general hospital?" @default.
- W2002539056 doi "https://doi.org/10.1002/uog.2925" @default.
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