Table 2.
Review of the literature on PUL: final outcome definitions
| First author | Country | IUP | EP | Miscarriage | Failed PUL | Persistent PUL | |
|---|---|---|---|---|---|---|---|
| El bishry (26) | 2008 | UK | - | - | - | - | - |
| Kirk (27) | 2007 | UK | TVS intra uterine gestational sac ± fetal pole ± cardiac activity, or heterogeneous tissue within endometrial cavity suggestive of retained products of conception | TVS blob sign, bagel sign, ectopic gestational sac with/without cardiac activity | - | hCG ratio < 0.87 day 0/7 | Analyzed as EPs |
| Florio (28) | 2007 | Italy | TVS intra uterine gestational sac | TVS adnexal mass, final diagnosis at laparoscopy and histology | Histology after evacuation of uterine contents | Spontaneous decrease of hCG to < 5 IU/L, with disappearance of symptoms | - |
| Condous (29) | 2007 | UK | TVS intra uterine gestational sac | TVS blob sign, bagel sign, ectopic gestational sac with/without cardiac activity and/or laparoscopy with histology of chorionic villi | - | P < 20nmol/L at presentation + fall in serum hCG < 5IU/L | Treated with MTX, location remains unknown, excluded in analysis |
| Hahlin (7) | 1995 | Sweden | - | Laparoscopic diagnosis | Histology after evacuation of uterine contents | Spontaneous resolution | - |
| Hajenius (8) | 1995 | NL | - | Strong suspicion EP thus indication for laparoscopy: Repeatedly negative TVS and hCG > 1000 IU/L. Plateauing hCG during follow-up. |
- | Trophoblast in regression, declining hCG during follow-up in a patient with a harmless clinical picture. Analyzed as no EP | - |
| Rivera (30) | 2009 | USA | Not applicable | hCG decrease < 50% after D&C and no chorionic villi at pathology | Abnormal IUP: hCG decrease ≥ 50% with chorionic villi Complete SAB: hCG decrease ≥ 50% without chorionic villi |
- | - |
| Dart (31) | 2002 | USA | Delivery or fetal heartbeat at TVS | EP visualized at laparoscopy, EP at follow-up TVS examination, hCG levels increase or plateau after D&Cand without villi at pathology | TVS abnormal sac, echogenic material, hCG > 3000 without intra uterine sac or decreasing hCG levels before curettage and evidence of chorionic villi at pathology No villi after curettage but hCG levels decreasing to zero without intervention No curettage and hCG levels that decrease to zero without intervention |
- | - |
| Barnhart (32) | 2002 | USA | Not applicable | Absence of chorionic villi or an increase in hCG after D&C, presence of chorionic villi in tube after laparoscopy | Presence of chorionic villi at pathology or consistent decline with complete resolution of hCG post operatively | - | - |
PUL pregnancy of unknown location; IUP intrauterine pregnancy; EP ectopic pregnancy; D&C dilation and curettage