Edinburgh TOP service introduced a protocol permitting women to proceed to treatment without further investigations if there were no signs, symptoms, or risk factors for ectopic pregnancy.

The present study was a retrospective audit that was conducted of outcomes of women presenting for TOP at less than or equal to six weeks’ gestation over 2 years using the hospital computerized database.

A total of one thousand one hundred and sixty-five women presented for TOP with an ultrasound gestational age of less than or equal to six weeks. One thousand and thirty had ultrasound evidence of a yolk sac. Eighty-seven women had an eccentrically placed gestational sac with a decidual reaction. All eighty-seven women fulfilled inclusion criteria to proceed to medical TOP, and sixty-six did so. In the remaining twenty-one cases, further investigations were performed before they proceeded to medical TOP. Two medical TOPs failed, both in women whose initial ultrasound had shown a yolk sac.

The study concluded that women with ultrasound features consistent with a very early IUP and without signs, symptoms, or risk factors for ectopic pregnancy can proceed directly to medical TOP without the need for delay for further ultrasonography.

Reference: https://srh.bmj.com/content/41/2/90