Ectopic Pregnancy and Pregnancy of Unknown Location
Ectopic pregnancy (EP) represents the implantation of a fertilised ovum outside the uterine cavity. Majority of ectopic pregnancies are located in the fallopian tubes [27]. Other locations include ovaries and abdominal cavity. Some ectopic pregnancies suc
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Ghada Salman and Davor Jurkovic
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Ectopic pregnancy (EP) represents the implantation of a fertilised ovum outside the uterine cavity. Majority of ectopic pregnancies are located in the fallopian tubes [27]. Other locations include ovaries and abdominal cavity. Some ectopic pregnancies such as cervical, Caesarean and intramural ectopic are located inside the uterus, but outside the uterine cavity typically invading the myometrium. The estimated incidence of ectopic pregnancy is 1–2 % worldwide [12]. Although death after ectopic pregnancy is rare, it is still considered as one of the leading causes for maternal morbidity and mortality [71]. The burden of disease is also high in view of the high cost of diagnostic tests and treatment [76]. Early identification and correct diagnosis of women with ectopic pregnancies are crucial for reducing the adverse outcomes associated with this condition. The clinical triad of vaginal spotting and pain with a palpable mass has been used traditionally to diagnose ectopic pregnancies. Unfortunately this is neither accurate nor specific. In one study, less than half of the women with EP had this triad, and in only 10–15 % of women suspected clinically to have EP the diagnosis was confirmed [65]. Improvement in non-invasive diagnostic methods, such as sensitive urine pregnancy tests and high-resolution transvaginal sonography, has enabled more accurate and earlier diagnosis of ectopic pregnancy. As a consequence, the clinical presentation of ectopic pregnancy has changed from a life-threatening disease, often necessitating emergency surgery, to a relatively benign condition, which is frequently asymptomatic or minimally symptomatic. This change of presentation has facilitated the use of non-surgical treatment options in recent years [5, 32, 52–54].
G. Salman (*) • D. Jurkovic The Early pregnancy and Gynaecology Diagnostic Unit, University College London Hospital, London, UK e-mail: [email protected] © Springer International Publishing Switzerland 2017 S. Guerriero et al. (eds.), Managing Ultrasonography in Human Reproduction, DOI 10.1007/978-3-319-41037-1_13
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G. Salman and D. Jurkovic
Despite advances in imaging and laboratory testing in some women, the site of pregnancy cannot be determined at the initial presentation. Pregnancy of unknown location (PUL) is a term that refers to the inability to visualise a pregnancy on transvaginal ultrasound scan in a clinically stable woman with a positive pregnancy test. The rate of PULs in individual department varies between 7 and 30 %, and it reflects differences in the quality of diagnostic service and organisational setup [43]. The majority of PULs represent complete miscarriages, which are undetectable on ultrasound scan and in whom human chorionic gonadotropin (hCG) declines uneventfully to pre-pregnancy levels. In the remaining cases, hCG levels tend to plateau or rise, and either an intrauterine or ectopic pregnancy is eventually detected on follow-up scans. Some authors use the term persistent PUL in case
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