Pregnancy of Unknown Location (PUL)

What is PUL?

• Pregnancy of unknown location (PUL) is when you have a positive urine (pee) or blood pregnancy test and the pregnancy cannot be seen on ultrasound.
• When you have a PUL, it is very important that we find where the pregnancy is located.
• Your care team will decide if the pregnancy can grow safely or if you will need treatment.

What are reasons a pregnancy cannot be seen on ultrasound?

• It is too early in the pregnancy to see with ultrasound.
• A person is having a miscarriage.
• There is an ectopic pregnancy.

What is an ectopic pregnancy?

• It is a pregnancy that started outside the uterus.
• Ectopic pregnancies happen most often inside the fallopian tube. It can also be called a “tubal pregnancy.” 2 out of 100 pregnancies will be outside of the uterus (ectopic).

Other places an ectopic pregnancy can be found are:

• The cervix
• A cesarean or c-section scar
• An ovary
• The abdomen (belly)

An ectopic pregnancy is life threatening.

• An ectopic pregnancy is never normal. It cannot turn into a viable or safe pregnancy.
• You need close follow-up with:
  • Ultrasounds
  • Blood work
  • Visits with your care team

An ectopic pregnancy needs treatment with medicine or surgery because:

• It can be life threatening.
• It cannot turn into a viable or safe pregnancy.
• It cannot be moved to the uterus or a different location.

What are treatments for an ectopic pregnancy?

• When found early, an ectopic pregnancy can be treated with a medicine called methotrexate.
• You may need a minor surgery to remove (take out) the pregnancy or your fallopian tube.

What symptoms should I look for?

Because you may have an ectopic pregnancy, it is very important you watch out for symptoms. Call right away or go to your emergency room if you have any of these symptoms. Do not wait until the clinic is open.

• Heavy vaginal bleeding (soaking through a pad in less than 1 hour)
• Abdominal (belly) pain that is severe or gets worse
• Lightheadedness or fainting (passing out)

Caring for yourself at home

Until the pregnancy is found, you should:

• Follow pelvic rest.
  • Do not douche, use tampons, or have vaginal sex.
• Drink lots of water.
• Take acetaminophen (Tylenol®) as needed. Follow the instructions on the bottle.
  • Do not take ibuprofen (such as Motrin®), aspirin, or other NSAID (nonsteroidal anti-inflammatory drug) medicines, unless told by your care team.
• Take your medicine unless told otherwise by your care team.

Follow-up

We need to follow you closely with a PUL.

You may need: 

• Blood test(s)
  • A serum beta human chorionic gonadotrophin (hCG) test is one of the most common blood tests that is needed.
    • It may be called a “quant.”
    • HCG is a hormone made by a pregnancy.
  • You will likely need to come back to get your second hCG 48 hours after this visit.
  • Your hCG level should go up by about 66% in that time if:
    • The pregnancy is normal.
    • The pregnancy is growing in your uterus.
• An ultrasound in 7 to 14 days
• Close follow-up visits with your care team.