Abstract
Objective
To compare days to diagnosis of pregnancy location for same-day medication abortion
and same-day uterine aspiration with delayed treatment (expectant management) in patients
with undesired pregnancy of unknown location (PUL).
Study design
We conducted a retrospective cohort study at a single Planned Parenthood health center
in Minnesota. We reviewed electronic health records and included patients presenting
for induced abortion diagnosed with PUL (positive high-sensitivity urine pregnancy
test and no evidence of intrauterine or extrauterine pregnancy on transvaginal ultrasonography)
without symptoms or ultrasonographic imaging concerning for ectopic pregnancy (low
risk). The primary outcome was days to pregnancy location clinical diagnosis.
Results
Of 19,151 abortion encounters in 2016–2019, 501 (2.6%) had a low-risk PUL. Participants
chose delay-for-diagnosis before treatment (148, 29.5%), immediate treatment medication
abortion (244, 48.7%), or immediate treatment uterine aspiration (109, 21.8%). Median
days to diagnosis were significantly lower in the immediate treatment uterine aspiration
group (2 days, IQR 1–3 days, p < 0.001) and similar for immediate treatment medication abortion (4 days, IQR 3–9
days, p = 0.304) compared with delay-for-diagnosis (3 days, IQR 2–10 days). Thirty-three
low-risk participants (6.6%) were treated for ectopic pregnancy, but no difference
in ectopic rate was detected among groups (p = 0.725). Participants in the delay-for-diagnosis group were more likely to be nonadherent
with follow-up (p < 0.001). For participants who completed follow-up, abortion completion rate was
lower for immediate treatment medication abortion (85.2%) compared with immediate
treatment uterine aspiration (97.6%, p = 0.003).
Conclusions
For patients with undesired PUL, diagnosis of pregnancy location was fastest with
immediate treatment uterine aspiration and similar for expectant management and immediate
treatment medication abortion. Medication abortion efficacy may be reduced in treatment
of undesired PUL.
Implications
For PUL patients desiring induced abortion, the option of proceeding at initial encounter
may help improve access and patient satisfaction. Uterine aspiration for PUL may help
diagnose pregnancy location more quickly.
Keywords
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Article info
Publication history
Published online: February 15, 2023
Accepted:
February 10,
2023
Received in revised form:
January 26,
2023
Received:
November 5,
2022
Publication stage
In Press Corrected ProofFootnotes
☆Conflicts of interest: None of the authors have any related conflicts of interest.
☆☆Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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© 2023 Elsevier Inc. All rights reserved.
