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Practice Five Things To Know About …

Pregnancy of unknown location

Tal Milman, Melissa Walker and Jackie Thomas
CMAJ September 28, 2020 192 (39) E1132; DOI: https://doi.org/10.1503/cmaj.200142
Tal Milman
Department of Obstetrics and Gynaecology (Milman, Walker, Thomas), University of Toronto; Sinai Health System (Thomas), Toronto, Ont.
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Melissa Walker
Department of Obstetrics and Gynaecology (Milman, Walker, Thomas), University of Toronto; Sinai Health System (Thomas), Toronto, Ont.
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Jackie Thomas
Department of Obstetrics and Gynaecology (Milman, Walker, Thomas), University of Toronto; Sinai Health System (Thomas), Toronto, Ont.
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  • RE: Response to Dr. Pymar
    Tal Milman [MD]
    Posted on: 01 October 2020
  • RE: Pregnancy of unknown location, appendix 1- ectopic pregnancy patient information
    Helen Pymar [MD, MPH]
    Posted on: 28 September 2020
  • Posted on: (1 October 2020)
    RE: Response to Dr. Pymar
    • Tal Milman [MD], Obstetrics and Gynecology Resident, University of Toronto

    Dear Dr. Pymar, thank you for your words and response. Given that the information sheet is intended for patients, we erred on being overly inclusive. Our goal in creating this appendix is to improve the comfort of primary care providers in managing PUL on an outpatient basis and in doing so, reduce unnecessary interventions. Our thought was that this must be balanced with an abundance of caution and counseling.

    Patients should be counseled that they may experience some vaginal bleeding following speculum exams and transvaginal ultrasound, however heavy bleeding is a red flag and should prompt emergency department presentation.

    Competing Interests: None declared.

    References

    • Tal Milman, Melissa Walker, Jackie Thomas. Pregnancy of unknown location. CMAJ 2020;192:E1132-E1132.
  • Posted on: (28 September 2020)
    RE: Pregnancy of unknown location, appendix 1- ectopic pregnancy patient information
    • Helen Pymar [MD, MPH], Obstetrician Gynecologist, University of Manitoba

    Thank you for your Appendix 1 which is a helpful document for use with patients who present with a pregnancy of unknown location.

    I am questioning if vaginal bleeding should be removed from the reasons to go directly to the ED as it is a common presentation in patients with pregnancy of unknown location and would result in a lot of ED visits if included.

    Competing Interests: None declared.

    References

    • Tal Milman, Melissa Walker, Jackie Thomas. Pregnancy of unknown location. CMAJ 2020;192:E1132-E1132.
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In this issue

Canadian Medical Association Journal: 192 (39)
CMAJ
Vol. 192, Issue 39
28 Sep 2020
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Pregnancy of unknown location
Tal Milman, Melissa Walker, Jackie Thomas
CMAJ Sep 2020, 192 (39) E1132; DOI: 10.1503/cmaj.200142

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Pregnancy of unknown location
Tal Milman, Melissa Walker, Jackie Thomas
CMAJ Sep 2020, 192 (39) E1132; DOI: 10.1503/cmaj.200142
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    • Pregnancy of unknown location occurs in 10% of pregnant patients undergoing transvaginal ultrasound in the first trimester
    • Gynecology consultation is indicated if history and physical examination at any encounter suggest ectopic pregnancy
    • All patients with pregnancy of unknown location require a repeat β-hCG test 48 hours after initial testing
    • Empiric definitive management of pregnancy of unknown location is rarely warranted
    • Expectant management of pregnancy of unknown location is safe, provided there is consistent follow-up
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