Pregnancy of Unknown Location (PUL)

What does it mean?

A pregnancy of unknown location (PUL) means that you have tested positive for pregnancy in a urine or a blood test, but the ultrasound is unable to locate where the pregnancy is. 

What could be happening?

• It may be too early to see the pregnancy on an ultrasound scan
• A miscarriage may have already occurred
• The pregnancy might be outside the womb (known as an ectopic pregnancy)

We will follow-up with blood tests and/or ultrasound scans to find out more.

What happens next?

We will check the level of pregnancy hormone in your blood, called the beta human chorionic gonadotrophin (β-hCG), which is produced by the early placenta.

If your β-hCG level is high:

• You may need to repeat a detailed ultrasound scan at the radiology department to check for an ectopic pregnancy or confirm a normal pregnancy.

If your β-hCG level is low, you will be asked to repeat the blood test in two (2) days. Here is what we are looking for:

• The β-hCG level is usually expected to approximately double every two days in a normally growing early pregnancy.
• If this level drops significantly, it may suggest a miscarriage is happening
• If the level rises or falls slowly, or stays about the same, we may need further scans to look for an ectopic pregnancy.

In the early stages of pregnancy, it may take time to reach a diagnosis. You may need several visits, blood tests and ultrasound scans before we know more clearly what is happening.

When should you come back?

Light vaginal bleeding is common in early pregnancy and can often be monitored at home. But please seek medical attention immediately if you experience:

• Increasing or severe abdominal pain
• Heavy vaginal bleeding (more than a normal period)
• Feeling faint or dizzy

You can seek immediate medical attention at the Urgent O&G Centre, Basement 1, Women’s tower KKH any time.

If your symptoms are mild, you can call for a same day appointment at the Early Pregnancy Assessment Unit (EPAU):

Central appointments: 6294-4050
Alternative line: 6394-1199

The information above is also available for download in pdf format.