Glossary

Term · Loss and Complications

pregnancy of unknown location

Also: PUL, unknown location pregnancy

A positive pregnancy test where the early ultrasound cannot yet show where the pregnancy is. Doctors repeat blood tests and scans to find out.

In plain words

A pregnancy of unknown location is the label used when a pregnancy test is positive, but an early ultrasound does not show a pregnancy inside the uterus or anywhere else. It is common early in pregnancy, because it can be too early to see what is there. Most of these pregnancies turn out to be normal intrauterine pregnancies that were just too early to see. Some are miscarriages, and a small number are pregnancies, which grow outside the uterus. Because an ectopic pregnancy can be serious, the label means close follow-up with blood tests and repeat scans. Waiting can be very hard. A mother may feel scared, confused, or in limbo. If you have severe belly pain, heavy bleeding, shoulder-tip pain, or feel faint, go to the emergency room now.

The deeper version

Pregnancy of unknown location is defined as a positive pregnancy test with no intrauterine gestational sac and no extrauterine finding on , a category that includes early intrauterine pregnancy, failing pregnancy, and ectopic pregnancy. Management uses serial quantitative beta-hCG, with the rate of rise or fall guiding triage, alongside repeat ultrasound. ACOG Practice Bulletin 193 (2018) on tubal ectopic pregnancy describes diagnostic thresholds and management options. The discriminatory zone concept depends on the assay and ultrasound quality, and the reported proportion of PUL that proves ectopic varies across series. The main controversy concerns whether serial alone is sufficient, or whether early progesterone or repeat imaging should decide follow-up.

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Sources

  • American College of Obstetricians and Gynecologists — Practice Bulletin 193: Tubal Ectopic Pregnancy (2018)
  • Doubilet PM, Benson CB — Diagnostic criteria for nonviable pregnancy early in the first trimester. New England Journal of Medicine (2013)

The Mothership Topic Wiki is general information for mothers and the people who care for them. It is not medical, legal, or mental-health advice and does not create a provider relationship. Experiences posted by members are their own. In an emergency call 911. If you are having thoughts of harming yourself, call or text 988.