Pregnancy of unknown location

Tal Milman; Melissa Walker; Jackie Thomas

doi:10.1503/cmaj.200142

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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.