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• W4377014921 abstract "INTRODUCTION: In the United States, it is recommended that pregnancies of unknown location (PUL) are evaluated with serial β-hCG levels until undetectable or location identified. In Britain, a declining β-hCG level of greater than 50% is considered low risk for ectopic pregnancy, and serial β-hCG measurements are stopped. We sought to investigate the effectiveness of British criteria in excluding ectopic gestation in the management of PUL in an urban U.S. population. METHODS: Retrospective study, collection, and statistical analysis of key data points in all patients seen at Jamaica Hospital Medical Center over a 3-year period between January 1, 2019 and December 31, 2021, with PUL were performed. RESULTS: Of 260 patients evaluated for PUL, 52 (20%) were ultimately diagnosed with ectopic pregnancies, 72% (28%) with intrauterine pregnancies, and 136 (52%) with spontaneous or missed abortions. A greater than 50% decrease in β-hCG was identified in 62 (24%) patients and was significantly associated with nonectopic gestation ( P <.001). Of these patients, only one patient (1.6%) had an ectopic gestation. The β-hCG of the patient with ectopic declined from 649 to 240 in the first 48 hours, and then rose to 546 at 96 hours. A presumptive diagnosis of ectopic was made, for which methotrexate was administered. CONCLUSION: Retrospective application of British criteria for PUL successfully predicted greater than 98% of patients with low-risk gestation. Using this criterion would have resulted in 19% fewer visits and 19.9% fewer β-hCG levels drawn. However, one presumptive ectopic was missed. Public health guidelines must balance cost and safety criteria. Larger prospective studies with built-in safety mechanisms and strictly defined outcome criteria are needed to better characterize the safety profile and potential cost savings of the application of the British guidelines for PUL to a U.S. population." @default.
• W4377014921 created "2023-05-19" @default.
• W4377014921 creator A5021875517 @default.
• W4377014921 date "2023-05-01" @default.
• W4377014921 modified "2023-10-18" @default.
• W4377014921 title "Application of British Criteria for Evaluation of Pregnancies of Unknown Location [ID: 1381226]" @default.
• W4377014921 doi "https://doi.org/10.1097/01.aog.0000929892.73707.4d" @default.
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