A uterine pregnancy that has been diagnosed by ultrasound diagnosis practically excludes the presence of an ectopic (extra-uterine) pregnancy. The patient can be reassured that she doesn't have an ectopic pregnancy because in naturally conceived pregnancies the probability of concomitantly having a uterine pregnancy and an ectopic pregnancy is very low (only 1 in 4,000 - 8,000)
A patient has a Pregnancy of Uncertain Location when an early vaginal ultrasound does not show evidence of either an intrauterine or an ectopic pregnancy. Patient must be evaluated without delay because an ectopic pregnancy is subsequently found in seven to twenty percent (7-20%) of these women. Approximately 25-50% of women with ectopic pregnancies initially present with a pregnancy of uncertain location.
About 30 to 40 women die annually in the United States from ectopic pregnancy-associated hemorrhage. Although it is an important cause of pregnancy-related morbidity and mortality, ectopic implantation has been reported to occur in less than 1% of pregnancies in women presenting for induced abortion; and represent 1% to 2% of all pregnancies.
Finding a Pregnancy of Uncertain Location (PUL) in a woman that is certain of her decision to terminate her pregnancy is a good opportunity to detect an ectopic pregnancy in a significantly shorter time period and provide a non-surgical solution. When dealing with the possibility of an ectopic pregnancy, time is of the essence.
We may perform an Early Vacuum Aspiration (EVA) and a baseline quantitative serum hCG to measure the titer (amount) of hormone of pregnancy that is present before evacuating the uterus. A repeat hCG titer will be obtained in 24-48 hrs.
This diagnostic protocol is based on published evidence showing that the blood level of hCG declines by 50% in the initial 5-9 hrs following the surgical removal of pregnancy.
In over 80% of patients, the second hCG titer will decline at least by 20%, indicating that the unwanted pregnancy has been terminated and there is no ectopic pregnancy.
The possibility of ectopic pregnancy must be considered if the second hCG titer fails to decline or increases, and the microscopic examination of the uterine aspirate and/or repeat ultrasound do not show evidence of uterine pregnancy.
With this protocol, the diagnosis of ectopic pregnancy can be timely achieved before it ruptures and becomes a life-threatening surgical emergency. The diagnosis is made without the use of laparoscopy, at a stage that allows a safe, non-surgical treatment using medications that are effective in 85% of patients and can be used in the clinic instead of the hospital.
This proactive approach makes it possible to avoid surgery and/or blood transfusions and reduce the morbidity and mortality of ectopic pregnancy at substantial savings to the patient and health care system.
If you have any questions or would like more information, please contact All Women's Clinic at the following numbers:
Toll Free: (800) 867-1693 Local calls: (954) 772-HELP (4357) or (954) 772-0933
You also may text your questions to: (954) 805-5821
Our address is 2100 E Commercial Blvd, Fort Lauderdale, Florida 33308-3822
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