The study reevaluates the incidence and clinical significance of pseudogestational sacs in pregnancies of unknown location. Among over 1,200 patients, intrauterine fluid collections were far more commonly associated with intrauterine pregnancies than ectopic pregnancies, and their presence significantly reduced the relative risk of ectopic pregnancy. The authors conclude that pseudogestational sacs are rare, that sac size does not reliably distinguish ectopic from intrauterine gestation, and that diagnosis should incorporate the full clinical and sonographic context rather than reliance on fluid collection characteristics alone.