Pregnancy of unknown location: an evidence‐based approach to management

As women are presenting to early pregnancy assessment units at increasingly earlier gestations and are having earlier scans, the incidence of pregnancy of unknown location (PUL) is increasing. Although the vast majority will be failing PULs or intrauterine pregnancies, a small subset will be ectopic pregnancies; it is the detection of women in this group that poses the greatest challenge. Conservative management of PUL results in lower rates of unnecessary intervention, as the condition often resolves spontaneously; the difficulty is in determining which ones will not. Learning objectives: To learn about the definition and clinical outcomes. To appreciate the role of biochemical tests and ultrasound in the assessment of women with PUL. To learn about conservative, medical and surgical management options. Ethical issues: Is destroying a viable intrauterine pregnancy an acceptable cost for treating all ectopic pregnancies, given the limitations of diagnosis in PUL? Please cite this article as: Sagili H, Mohamed K. Pregnancy of unknown location: an evidence‐based approach to management. The Obstetrician & Gynaecologist 2008;10:224–230.