ABSTRACT

There are some important questions that need to be answered before discussing management. First and foremost, is the diagnosis of a PUL appropriate? Secondly, is the woman clinically stable? And thirdly, has the presence of blood in the pelvis been excluded on the ultrasound scan? Provided that the ultrasound examiner is sufficiently skilled and uses an ultrasound system with acceptable image quality, then the

diagnosis is certainly appropriate. If the woman is not clinically stable and/or haemoperitoneum is present on scan, then it is not appropriate to manage such women expectantly. Conversely, if clinically stable and there are no signs of haemoperitoneum on scan then a hands-off, non-interventional approach on an outpatient basis is the most appropriate way forward. This expectant management approach is safe1-9 as the vast majority of PULs are low-risk PULs and represent failing PULs or very early IUP.1,11 A ‘wait-and-see’ approach has been shown to be safe, reduce the need for unnecessary surgical intervention and is not associated with any serious adverse outcomes.1-9 We have unpublished data at St George’s Hospital, London, on more than 1000 consecutive women with a PUL and the overall rate of intervention in the form of a laparoscopy or evacuation of retained products is 8.2%. In this series there were no significant adverse outcomes.