Pregnancy of unknown location

The term pregnancy of unknown location is assigned when neither an intrauterine pregnancy (IUP) or an ectopic pregnancy is identified on transvaginal ultrasound in the context of a positive pregnancy test.

  • pelvic pain, vaginal bleeding
  • positive pregnancy test
  • serial beta-hCG: has an adjunct role in the diagnosis of ectopic pregnancy, and is useful in the follow-up of clinically stable patients 
  • serum progesterone: lack of progesterone has been considered an indication of nonviability 3
    • <5 ng/mL is a good indication of nonviability, however, larger values cannot exclude an ectopic pregnancy 4

Essentially these patients will present with a "normal" pelvic ultrasound, with no signs of an IUP and normal adnexa 5

In hemodynamically stable patients, serial quantitative beta-hCG levels and a repeat ultrasound examination in a short interval are the management of choice 5

A pregnancy of unknown location basically reflects three possibilities:

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Article information

rID: 15322
System: Obstetrics
Synonyms or Alternate Spellings:
  • Pregnancy of unknown location (PUL)
  • Pregnancy of uncertain location (PUL)
  • PUL
  • Gestation of unknown location

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