Pregnancy of unknown location
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Clinics |
Texto Completo: | https://www.revistas.usp.br/clinics/article/view/163200 |
Resumo: | Pregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists. |
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Pregnancy of unknown locationPregnancyEctopicProgesteroneHuman chorionic gonadotropinPregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists.Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo2019-10-14info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/xmlhttps://www.revistas.usp.br/clinics/article/view/16320010.6061/clinics/2019/e1111Clinics; v. 74 (2019); e1111Clinics; Vol. 74 (2019); e1111Clinics; Vol. 74 (2019); e11111980-53221807-5932reponame:Clinicsinstname:Universidade de São Paulo (USP)instacron:USPenghttps://www.revistas.usp.br/clinics/article/view/163200/156919https://www.revistas.usp.br/clinics/article/view/163200/156920Copyright (c) 2019 Clinicsinfo:eu-repo/semantics/openAccessPereira, Pedro PauloCabar, Fábio RobertoGomez, Úrsula TrovatoFrancisco, Rossana Pulcineli Vieira2019-10-14T13:32:28Zoai:revistas.usp.br:article/163200Revistahttps://www.revistas.usp.br/clinicsPUBhttps://www.revistas.usp.br/clinics/oai||clinics@hc.fm.usp.br1980-53221807-5932opendoar:2019-10-14T13:32:28Clinics - Universidade de São Paulo (USP)false |
dc.title.none.fl_str_mv |
Pregnancy of unknown location |
title |
Pregnancy of unknown location |
spellingShingle |
Pregnancy of unknown location Pereira, Pedro Paulo Pregnancy Ectopic Progesterone Human chorionic gonadotropin |
title_short |
Pregnancy of unknown location |
title_full |
Pregnancy of unknown location |
title_fullStr |
Pregnancy of unknown location |
title_full_unstemmed |
Pregnancy of unknown location |
title_sort |
Pregnancy of unknown location |
author |
Pereira, Pedro Paulo |
author_facet |
Pereira, Pedro Paulo Cabar, Fábio Roberto Gomez, Úrsula Trovato Francisco, Rossana Pulcineli Vieira |
author_role |
author |
author2 |
Cabar, Fábio Roberto Gomez, Úrsula Trovato Francisco, Rossana Pulcineli Vieira |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Pereira, Pedro Paulo Cabar, Fábio Roberto Gomez, Úrsula Trovato Francisco, Rossana Pulcineli Vieira |
dc.subject.por.fl_str_mv |
Pregnancy Ectopic Progesterone Human chorionic gonadotropin |
topic |
Pregnancy Ectopic Progesterone Human chorionic gonadotropin |
description |
Pregnancy of unknown location is a situation in which a positive pregnancy test occurs, but a transvaginal ultrasound does not show intrauterine or ectopic gestation. One great concern of pregnancy of unknown location is that they are cases of ectopic pregnancy whose diagnosis might be postponed. Transvaginal ultrasound is able to identify an ectopic pregnancy with a sensitivity ranging from 87% to 94% and a specificity ranging from 94% to 99%. A patient with pregnancy of unknown location should be followed up until an outcome is obtained. The only valid biomarkers with clinical application and validation are serum levels of the beta fraction of hCG and progesterone. A single serum dosage of hCG is used only to determine whether the value obtained is above or below the discriminatory zone, that means the value of serum hCG above which an intrauterine gestational sac should be visible on ultrasound. Serum progesterone levels are a satisfactory marker of pregnancy viability, but they are unable to predict the location of a pregnancy of unknown location: levels below 5 ng/mL are associated with nonviable gestations, whereas levels above 20 ng/mL are correlated with viable intrauterine pregnancies. Most cases are low risk and can be monitored by expectant management with transvaginal ultrasound and serial serum hCG levels, in addition to the serum progesterone levels. To minimize diagnostic error and intervene during progressive intrauterine gestation, protocol indicates active treatment only in situations when progressive intrauterine pregnancy is excluded and a high possibility of ectopic pregnancy exists. |
publishDate |
2019 |
dc.date.none.fl_str_mv |
2019-10-14 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/163200 10.6061/clinics/2019/e1111 |
url |
https://www.revistas.usp.br/clinics/article/view/163200 |
identifier_str_mv |
10.6061/clinics/2019/e1111 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/clinics/article/view/163200/156919 https://www.revistas.usp.br/clinics/article/view/163200/156920 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2019 Clinics info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2019 Clinics |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf application/xml |
dc.publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
publisher.none.fl_str_mv |
Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo |
dc.source.none.fl_str_mv |
Clinics; v. 74 (2019); e1111 Clinics; Vol. 74 (2019); e1111 Clinics; Vol. 74 (2019); e1111 1980-5322 1807-5932 reponame:Clinics instname:Universidade de São Paulo (USP) instacron:USP |
instname_str |
Universidade de São Paulo (USP) |
instacron_str |
USP |
institution |
USP |
reponame_str |
Clinics |
collection |
Clinics |
repository.name.fl_str_mv |
Clinics - Universidade de São Paulo (USP) |
repository.mail.fl_str_mv |
||clinics@hc.fm.usp.br |
_version_ |
1787713181446045696 |