Combined use of cell phone technology, serum Progesterone and ß-HCG can reduce the extra visits in the management of pregnancy of unknown location in law resource settings

Objectives: The aim of this study was to evaluate efficacy and safety of the combined use of mobile phone and serum progesterone in the management of patients with pregnancy of unknown location.
 
Material & methods: A prospective interventional study was introduced to the emer- gency ward for managing all patients attended to emergency gynecological ward in El Minya maternity university hospital between the period of 1st of August 2010 and 31st of October 2011 whereby clinically stable patients with PUL and serum progesterone level less than 10 nmol/l were discharged after initial visit. Patients were advised to contact emergency mobile number to two dedicated persons (author & co-author) who follow a chart of symptoms & reading of serum levels of progesterone and incorporate the human chorionic gonadotropin (β-hCG) /48 h ratio if necessary.
Surgical or medical intervention was offered to all women with persistent or worsening symptoms and non-declining serum β-hCG.
 
Results: During 15 months of the study period (from the 1st of August 2010 and 31st of October 2011),675 pregnant women had a clinical and ultrasound diagnosis of PUL with serum progesterone level less than 10 nmol/l were attended to our emergency unit. 590 were included in the final data analysis. The final outcomes were four groups, the first one was the normal intrauterine pregnancy group which was diagnosed in 9 (1.5 %) cases
.The second group in which 30 (5.1 %) of the recruited cases, had the diagnosis of mis- carriage. In the third group, the site of pregnancy was never determined in 538 (91.2 %) cases (neither intra-uterine nor extra –uterine) and they resolved spontaneously without any intervention .The fourth group which was consisted of 13 cases (2.2%) diagnosed as ectopic pregnancy .From the above figures it is well evident that, the initial level of progesterone was found to predict the outcome of PUL. There was significant reduction in the number of visits (P <0.001).
 
Conclusions: The introduced protocol based upon combined use of mobile phone tech- nology, serum progesterone less than 10 nmol/l at law risk of developing complications and if combined with β-hCG 48 h/48 h ratio notification will be effective in reducing the extra visits & costs and help in triaging women with PULs without significant maternity harm especially in law resource settings.