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Pregnancy of Unknown Origin Explained

Pregnancy of unknown location (PUL) is a term common to your gynecologist, but confusing to a pregnant woman.

Pregnancy tests are positive when there is no enlargement to the uterus or visible pregnancy that can be seen on ultrasound.

In fact this condition can persist for a week or rarely two until your gynecologist can determine what the condition of the pregnancy is.

It’s so common now there are reports that as many as half of all pregnancies go through this stage.

Because not everyone’s pregnancy progresses normally, and because sometimes early pregnancies, early miscarriages, and tubal pregnancies can all have blood counts that are similar, and until more testing, it’s not possible to obtain a firm diagnosis.

Few pregnancies end up as ectopic, growing in the fallopian tubes but in fact some do.

An ectopic pregnancy can be a serious condition that requires medical attention and if there are no signs of intrauterine pregnancy or an extrauterine pregnancy via transvaginal ultra-sonography, it is not always possible to determine the location of the pregnancy.

In general, doing blood tests like looking for anemia, observing for medical problems such as pelvic pain, doing one or more sonographic evaluations, and most important repeating at intervals blood testing for pregnancy called human chorionic gonadotropin (hCG) measurements will determination of the location of pregnancy.

Although in the past more often surgical intervention such as taking tissue from the uterus or performing laparoscopy to determine or confirm the location of pregnancy, usually these steps don’t need to be done.

Problem pregnancies such as a miscarriage or tubal pregnancy, oddly may resolve spontaneously without any treatment, but your gynecologist is going to want you to follow up closely and not just assume these will resolve without treatment.


Suzanne Trupin, MD, Board Certified Obstetrician and Gynecologist and owner of Women's Health Practice, Hada Cosmetic Medicine, and Hatha Yoga and Fitness

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