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- Title
Trends in the Management of Nonviable Pregnancies of Unknown Location in the United States.
- Authors
Parks, Melissa A.; Barnhart, Kurt T.; Howard, David L.
- Abstract
<bold>Background: </bold>When managing a nonviable pregnancy of unknown location (PUL), a debate has emerged in the literature whether to perform uterine curettage for definitive diagnosis of pregnancy location or administer methotrexate for a presumed ectopic pregnancy. The purpose of this study is to describe the treatment patterns when managing a PUL.<bold>Methods: </bold>A prospective, anonymous Internet based-electronic survey of PUL case scenarios was administered to a random sample of physicians across the United States.<bold>Results: </bold>A total of 214 physicians responded. When presented with a PUL by ultrasound and a βhCG measurement of 3,270 mIU/mL, which is above the discriminatory level, 88.3% (188) would choose an additional βhCG measurement before recommending any intervention. When presented with a PUL by ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable gestation, 36.5% would offer uterine curettage and 31.3% would offer methotrexate. Resident and private clinicians had a fourfold lower adjusted odds of choosing uterine curettage compared to academic physicians.<bold>Conclusions: </bold>Based on our findings, there does not appear to be a consensus regarding the management of a PUL.
- Subjects
UNITED States; CURETTAGE; OPERATIVE surgery; METHOTREXATE; PHYSICIANS; OBSTETRICS; ECTOPIC pregnancy; ABORTIFACIENTS; CHORIONIC gonadotropins; LONGITUDINAL method; SURVEYS; ULTRASONIC imaging; DILATATION &; curettage; THERAPEUTICS
- Publication
Gynecologic & Obstetric Investigation, 2018, Vol 83, Issue 6, p552
- ISSN
0378-7346
- Publication type
journal article
- DOI
10.1159/000488760