Pregnancy of Un-Known Location: Need for Evolving New Protocols and Evaluation of Tools for Increasing Outcome Predictability

Ascertaining pregnancy location is the key determinant for streamlining management for patients presenting with abdominal pain or bleeding in early pregnancy. However sometimes in spite of all efforts finding the location of gestation sac is difficult and such cases have been classified categorised as Pregnancy of Unknown Location (PUL). The lack of well accepted consensus for diagnostic criteria for PUL is reflected by differences in the management strategies of PUL. As locating early pregnancy is dependent on many factors therefore incidence of PUL varies in different setup. According to recent reports the Specialist unit reported that to around 8-10% vs 8-31% in non-specialist Unit [1]. PUL outcome data is very encouraging from hospitals that have developed clear PUL care pathways incorporating reliable diagnostic criteria. Only few UK units have opted their PUL management based on a clear predictive tool including widely accepted hormone tests. Hence we conducted a prospective study to review PUL managed cases and aimed to propose a PUL management pathway and thereby reducing variation.