Community-generated resource library-Pregnancy of unknown location: A consensus statement of nomenclature, definitions and outcome

Pregnancy of unknown location: A consensus statement of nomenclature, definitions and outcome

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The consensus statement on the management of pregnancies of unknown location (PUL) aims to standardize terminology and outcomes to improve future research and clinical care. A PUL occurs when a woman has a positive pregnancy test but neither an intrauterine nor an ectopic pregnancy (EP) is visible on ultrasound (TVS). The statement proposes a classification system for initial ultrasound findings into five categories: definite EP, probable EP, PUL, probable intrauterine pregnancy (IUP), and definite IUP.<br /><br />According to this statement, after the initial diagnosis, patients should be monitored, and the final outcomes categorized into visualized EP or IUP, spontaneously resolved PUL, or persisting PUL. Persisting PULs are further classified based on subsequent management, whether they are non-visualized EPs, treated persistent PULs, resolved persistent PULs, or histologically confirmed IUPs. The statement emphasizes that clear definitions are essential for comparing and generalizing research findings, leading to better reproduction prognoses and improved clinical care for women with PUL.<br /><br />Global diagnostic strategies differ; European countries often use hCG ratios over 48 hours, while the USA trend includes qualitative and aggressive measurements to distinguish viability early on. The UK and Europe lean towards conservative, prolonged monitoring. Despite advanced diagnostic methods, each region uses different criteria regarding diagnostic and treatment thresholds for PULs.<br /><br />The consensus urges defining study populations and outcomes meticulously to enable objective analysis. Distinct final outcome definitions, such as visualized versus non-visualized outcomes and whether they are confirmed histologically or through resolution patterns, are crucial for understanding the reproductive impact of PULs.<br /><br />Overall, the statement's aim is to facilitate international research collaboration by ensuring consistency in definitions and outcome classifications in women initially diagnosed with a PUL, potentially leading to improved patient care outcomes.

Keywords

pregnancies of unknown location

PUL management

standardized terminology

ultrasound classification

ectopic pregnancy

intrauterine pregnancy

hCG ratios

diagnostic strategies

reproductive prognoses

international collaboration