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Pregnancy of Unknown Location (PUL)

Patient Education
Last reviewed

What is PUL?

Pregnancy of unknown location (PUL) is when you have a positive urine or blood pregnancy test, and the pregnancy cannot be seen on ultrasound. When you have a PUL, it must be found. Your care team will decide if it will grow safely. 

Why we cannot see it on ultrasound?

  • It is too early to see
  • 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. 

  • This can be life threatening
  • It is never normal
  • You will need close follow up with:
    • Ultrasounds
    • Blood work
    • Visits with your care team

Ectopic pregnancies happen most often inside the fallopian tube. It can also be called a “tubal pregnancy.”

Other places they can be found are:

  • The cervix
  • A c-section scar
  • An ovary
  • The abdomen

2 out of 100 pregnancies will be outside of the uterus (ectopic).

The pregnancy cannot carry on because:

  • They can be life threatening
  • Cannot be a viable pregnancy
  • Cannot be moved to the uterus

When found early, some can be treated with a medicine called methotrexate. You may need a minor surgery to remove the pregnancy or your fallopian tube.

Caring for yourself at home

Until the pregnancy is found, you should:

  • Get pelvic rest (do not douche, use tampons, or have sex). 
  • Not take ibuprofen, Motrin®, aspirin, or other NSAID medicines
  • Take acetaminophen (Tylenol®) as needed.
  • Drink lots of water
  • Take your medicine unless told by your care team

Do not wait until the clinic is open. Call right away or go to your emergency room if you have:

 

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

Follow-up

Close follow-up is needed for a PUL

  • A blood test. This test is known as a serum beta human chorionic gonadotrophin (HCG). It may be called a qaunt
    • Return 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
      • it is growing in your uterus
  • An ultrasound in 7 to 14 days

You need to return to have tests done.

Call:

The Women’s Health Clinic at 1-319-356-2294 Monday through Friday from 8 a.m. to 4:30 p.m. 

For urgent questions or concerns

  • Call the Hospital Operator at 1-319-356-1616 on nights, weekends, and holidays
  • Ask for the gynecology resident on call.

Toll-free at 1-800-777-8442, 24 hours a day

  • Ask for the gynecology resident on call. 

Send a MyChart message for non-urgent questions or concerns.