Pregnancy After Care: Pregnancies of unknown location (PULs)

PULs account for 10% of all early pregnancy scans. In this clinical situation there is no sign of pregnancy inside or outside the womb (uterus) on scan. A PUL does NOT mean that you have an ectopic pregnancy. Close hormonal follow-up and ultrasound form the cornerstone of management for women with a PUL.

Under these circumstances, there are three possible outcomes:

• Failing pregnancy (either complete miscarriage or self-limiting form of ectopic pregnancy)
• Ongoing intra-uterine pregnancy
• Ongoing extra-uterine or ectopic pregnancy

At OMNI, expectant management in conjunction with measurements of the pregnancy hormone hCG over 48 hours has been shown to be safe. This approach also allows us to predict the most likely outcome for your early pregnancy.

If the serum hCG levels fall over 48 hours, then this represents a failing pregnancy and repeat serum hCG levels will be arranged 7 days later to confirm the diagnosis. If the serum hCG levels increase over 48 hours, then a repeat scan will be arranged 7 days later to confirm the location of the pregnancy. Most women with increasing levels of serum hCG at 48 hours will go on to have a normal pregnancy and not an ectopic pregnancy.