Persistent Pregnancy of Unknown Location: Which Strategy Is Best?

A randomized trial finds uterine aspiration or methotrexate preferable to expectant management.

Among women presenting with early pregnancies, ultrasound often fails to identify the implantation site. In one third of such pregnancies, monitoring serum human chorionic gonadotropin (hCG) levels suggests neither a viable pregnancy nor a resolving pregnancy loss. Such pregnancies are considered persistent pregnancies of unknown location (PUL). Their optimum management is uncertain.

In a multicenter trial, 255 women with persistent PUL were randomized to uterine aspiration followed by methotrexate (MTX), if indicated; primary MTX treatment; or expectant management. Many participants declined the assigned treatment and crossed over to a different treatment: 48% declined uterine aspiration, 42% primary MTX, and 27% expectant management. Ultim…

Reviewing Author

Andrew M. Kaunitz, MD

Disclosures

RoyaltiesUpToDate

Grant/Research SupportMerck, Mithra, Medicines360

Editorial BoardsContraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health

Andrew M. Kaunitz, MD

Disclosures

RoyaltiesUpToDate

Grant/Research SupportMerck, Mithra, Medicines360

Editorial BoardsContraception; Menopause; Contraceptive Technology Update; OBG Management; Medscape OB/GYN & Women’s Health

Persistent Pregnancy of Unknown Location: Which Strategy Is Best?

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Reviewing Author