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Ectopic Pregnancy: Pregnancy of Unknown Location (PUL)

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First-Trimester Ultrasound

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Abstract

Pregnancy of unknown location (PUL) is a recognized diagnosis when ultrasound fails to identify a pregnancy’s location in patients with a positive hCG. Expectant management is appropriate in hemodynamically stable patients with a PUL, as most PULs represent failing intrauterine pregnancies. Appropriate and timely follow-up with serial hCG levels, serum progesterone levels in select cases, and high-level ultrasound will identify the location and viability status of most pregnancies.

There are characteristic endometrial and adnexal findings with ectopic pregnancy. These are reviewed in this chapter. Ultrasound is an excellent first-line test as 50 % of ruptured ectopic pregnancies have a hCG < 1000 mIU/mL, thus identifying patients appropriate for immediate surgical intervention. However, observation is appropriate in stable patients as spontaneous resolution occurs in 25–88 % of patients, depending on the initial hCG level.

There are numerous unusual locations for ectopic pregnancies, including heterotopic, interstitial, cornual, angular, ovarian, abdominal, and cervical pregnancies. The diagnostic criteria for each of these are reviewed.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA

    Linda Do MD & James M. Shwayder MD, JD

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  1. Linda Do MD
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  2. James M. Shwayder MD, JD
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Correspondence to James M. Shwayder MD, JD .

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Editors and Affiliations

  1. Division of Maternal-Fetal Medicine Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA

    Jacques S. Abramowicz

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Do, L., Shwayder, J.M. (2016). Ectopic Pregnancy: Pregnancy of Unknown Location (PUL). In: Abramowicz, J. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-319-20203-7_16

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  • DOI: https://doi.org/10.1007/978-3-319-20203-7_16

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20202-0

  • Online ISBN: 978-3-319-20203-7

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