TY  - JOUR
T1  - Diagnosis and Management of Pregnancy of Unknown Location: A Retrospective Cohort Study in a Tertiary Care Center
AU - Ashok, Binusha AU - Nair, Rema 
JO  - Research Journal of Medical Sciences
VL  - 18
IS  - 12
SP  - 988
EP  - 992
PY  - 2024
DA  - 2001/08/19
SN  - 1815-9346
DO  - makrjms.2024.12.988.992
UR  - https://makhillpublications.co/view-article.php?doi=makrjms.2024.12.988.992
KW  - Pregnancy of unknown location
KW  - PUL
KW  - ectopic pregnancy
KW  - β‐hCG
KW  - transvaginal ultrasound
KW  - expectant management
KW  - methotrexate
AB  - Pregnancy of Unknown Location (PUL) is a diagnostic challenge in early
pregnancy, where initial ultrasonography fails to locate the pregnancy
despite a positive pregnancy test. Managing PUL is essential to promptly
identify ectopic pregnancies while avoiding unnecessary interventions in
cases that may resolve spontaneously. This study aims to evaluate
diagnostic approaches, management strategies and clinical outcomes in
women diagnosed with PUL in a tertiary care setting. This retrospective
cohort study analyzed 15 women diagnosed with PUL from January
2022 to December 2023 at a tertiary care center. Data on patient
demographics, clinical presentation, diagnostic modalities (serial
β‐hCG and transvaginal ultrasound) and management approaches were
collected. Outcomes included resolution of PUL, confirmation of
intrauterine or ectopic pregnancy and any complications. Statistical
analysis was conducted to identify factors predictive of ectopic
pregnancy. The mean age of participants was 30 years, with 67%
presenting symptomatically. Initial diagnostic evaluation included
transvaginal ultrasound and serial β‐hCG measurements in all cases, while
laparoscopy was utilized in 20% of cases with inconclusive imaging.
Expectant management was successful in 83% of selected cases, while
Methotrexate resolved 80% of medically managed cases. Surgical
intervention was required for confirmed ectopic pregnancies (27%).
Factors predictive of ectopic pregnancy included initial β‐hCG levels
>1500 IU/L, absence of a gestational sac and presence of pelvic free fluid
(p<0.05). Overall, 33% of PUL cases resolved spontaneously, 33% were
confirmed ectopic pregnancies and 20% progressed to confirmed
intrauterine pregnancies. This study demonstrates the utility of a
structured approach combining serial β‐hCG and transvaginal ultrasound
in managing PUL. Expectant management is effective in cases with lowrisk
factors, while high‐risk features should prompt closer monitoring
and potential intervention. Identifying predictive factors for ectopic
pregnancy helps optimize patient outcomes and reduce unnecessary
interventions in PUL cases.
ER  -