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Diagnostic algorithm in pregnancies of uncertain viability or unknown location – a review of the latest recommendations


Authors: D. Fischerová 1;  F. Frühauf 1;  L. Břešťáková 2
Authors place of work: Gynekologicko-porodnická klinika VFN a 1. LF UK, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  ProfiG2, s. r. o., Praha 2
Published in the journal: Ceska Gynekol 2014; 79(3): 231-238

Summary

Based on current knowledge the criteria for diagnosing nonviability in early intrauterine pregnancy and diagnostic algorithm in pregnancies of unknown location have changed. For either an intrauterine pregnancy of uncertain viability or a pregnancy of unknown location, the consequences of false positive diagnosis of nonviability or false negative diagnosis of ectopic pregnancy may be dire: harming of a potentially normal intrauterine pregnancy or a life-threatening rupture from tubal pregnancy. This review aims to present the most important results of current studies on this topic with their recommendations and to improve patient care reducing the risk of inadvertent harm to potentially normal pregnancies.

Keywords:
intrauterine pregnancy of uncertain viability, pregnancy of unknown location, ultrasound, hCG, ectopic pregnancy, miscarriage


Zdroje

1. Abdallah, Y., Daemen, A., Guha, S., et al. Gestational sac and embryonic growth are not useful as criteria to define miscarriage: a multicenter observational study. Ultrasound Obstet Gynecol, 2011, 38, 5, p. 503–509.

2. Abdallah, Y., Daemen, A., Kirk, E., et al. Limitations of current definitions of miscarriage using mean gestational sac diameter and crown-rump length measurements: a multicenter observational study. Ultrasound Obstet Gynecol, 2011, 38, 5, p. 497–502.

3. Barnhart, K., van Mello, NM., Bourne, T., et al. Pregnancy of unknown location: a consensus statement of nomenclature, definitions, and outcome. Fertil Steril, 2011, 95, 3, p. 857–866.

4. Bree, RL., Edwards, M., Bohm-Velez, M., et al. Transvaginal sonography in the evaluation of normal early pregnancy: correlation with HCG level. AJR Am J Roentgenol, 1989, 153, 1, p. 75–79.

5. Bromley, B., Harlow, BL., Laboda, LA., Benacerraf, BR. Small sac size in the first trimester: a predictor of poor fetal outcome. Radiology, 1991, 178, 2, p. 375–357.

6. Condous, G., Kirk, E., Lu, C., et al. Diagnostic accuracy of varying discriminatory zones for the prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol, 2005, 26, 7, p. 770–775.

7. Condous, G., Timmerman, D., Goldstein, S., et al. Pregnancies of unknown location: consensus statement. Ultrasound Obstet Gynecol, 2006, 28, 2, p. 121–122.

8. Condous, G., Van Calster, B., Kirk, E., et al. Prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol, 2007, 29, 6, p. 680–687.

9. Cordina, M., Schramm-Gajraj, K., Ross, JA., et al. Introduction of a single visit protocol in the management of selected patients with pregnancy of unknown location: a prospective study. BJOG, 2011, 118, 6, p. 693–697.

10. Day, A., Sawyer, E., Mavrelos, D., et al. Use of serum progesterone measurements to reduce need for follow-up in women with pregnancies of unknown location. Ultrasound Obstet Gynecol, 2009, 33, 6, p. 704–710.

11. Doubilet, PM., Benson, CB. Further evidence against the reliability of the human chorionic gonadotropin discriminatory level.J Ultrasound Med, 2011, 30, 12, p. 1637–1642.

12. Doubilet, PM., Benson, CB., Bourne, T., et al. Diagnostic criteria for nonviable pregnancy early in the first trimester. N Engl J Med, 2013, 369, 15, p. 1443–1451.

13. Fischerova, D., Břešťák, M., Zikan, M. Těhotenství neznámé lokalizace. Mod Gynek, 2007, 16, 4, s. 649–660.

14. Fischerová, D., Pašková, A., Břešťák, M. Těhotenství neznámé lokalizace. In Calda, P. Ultrazvuková diagnostika v těhotenství a gynekologii. Praha: Aprofema s.r.o., 2010, s. 428–432.

15. Goldstein, I., Zimmer, EA., Tamir, A., et al. Evaluation of normal gestational sac growth: appearance of embryonic heartbeat and embryo body movements using the transvaginal technique. Obstet Gynecol, 1991, 77, 6, p. 885–888.

16. Kirk, E., Condous, G., Van Calster, B., et al. Rationalizing the follow-up of pregnancies of unknown location. Hum Reprod, 2007, 22, 6, p. 1744–1750.

17. Kirk, E., Daemen, A., Papageorghiou, AT., et al. Why are some ectopic pregnancies characterized as pregnancies of unknown location at the initial transvaginal ultrasound examination? Acta Obstet Gynecol Scand, 2008, 87, 11, p. 1150–1154.

18. Kirk, E., Condous, G., Bourne, T. Pregnancies of unknown location. Best Pract Res Clin Obstet Gynaecol, 2009, 23, 4, p. 493–499.

19. Kirk, E., Bottomley, C., Bourne, T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Hum Reprod Update, 2013.

20. Lindsay, DJ., Lovett, IS., Lyons, EA., et al. Yolk sac diameter and shape at endovaginal US: predictors of pregnancy outcome in the first trimester. Radiology, 1992, 183, 1, p. 115–118.

21. Pexsters, A., Luts, J., Van Schoubroeck, D., et al. Clinical implications of intra- and interobserver reproducibility of transvaginal sonographic measurement of gestational sac and crown-rump length at 6–9 weeks‘ gestation. Ultrasound Obstet Gynecol, 2011, 38, 5, p. 510–515.

22. Van Calster, B., Abdallah, Y., Guha, S., et al. Rationalizing the management of pregnancies of unknown location: temporal and external validation of a risk prediction model on 1962 pregnancies. Hum Reprod, 2013, 28, 3, p. 609–616.

23. van Mello, NM., Mol, F., Opmeer, BC., et al. Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. Hum Reprod Update, 2012, 18, 6, p. 603–617.

24. Yegul, NT., Filly, RA. Further observations on the empty „amnion sign“. J Clin Ultrasound, 2010, 38, 3, p. 113–117.

Štítky
Detská gynekológia Gynekológia a pôrodníctvo Reprodukčná medicína

Článok vyšiel v časopise

Česká gynekologie

Číslo 3

2014 Číslo 3
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