Management of undesired pregnancy of unknown location and abortion at less than 42 days of gestation-Management of undesired pregnancy of unknown location and abortion

Video Transcription

Video Summary

This comprehensive webinar, presented by experts in family planning, addresses the management of undesired pregnancy of unknown location (PUL) and abortion within 42 days gestation. Key objectives include clarifying ultrasound-based definitions and classifications of early pregnancy findings—from definitive intrauterine pregnancy (IUP) to ectopic pregnancy—and updating clinical protocols accordingly. The presenters emphasized the increasing trend of early pregnancy diagnosis, which raises demand for early abortion care and challenges previous reliance on confirming an intrauterine pregnancy before treatment initiation.<br /><br />Ultrasound findings in PUL show no visible intrauterine or extrauterine pregnancy, posing risk for ectopic pregnancy—though ectopic rates in abortion-seeking patients are under 1%, with higher risk (~4-8%) in true PUL cases. Management involves patient-centered options: immediate procedural management via uterine aspiration with tissue examination to confirm pregnancy location, or medication management using mifepristone and misoprostol. Recent studies demonstrate the safety and effectiveness of medication abortion in PUL, though efficacy is somewhat lower than for known IUPs. Serial quantitative hCG monitoring is critical to confirm pregnancy resolution and exclude ectopic pregnancy.<br /><br />Guidelines recommend baseline and follow-up hCG measurements post-treatment, with specific decline thresholds for confirming abortion completion. They caution against applying no-test medication abortion protocols to PUL patients due to higher ectopic risk requiring ultrasound-based risk stratification and close follow-up. Overall, the webinar stresses evidence-based, nuanced care balancing prompt abortion access with safe diagnosis and management of PUL complexities.

Keywords

pregnancy of unknown location

PUL management

early pregnancy ultrasound

ectopic pregnancy risk

medication abortion

mifepristone

misoprostol

hCG monitoring

abortion protocols