Pregnancy of Unknown Location (PUL)

Pregnancy of unknown location is not a final diagnosis, but a temporary clinical classification while a definitive diagnosis on the pregnancy type / outcome can be made.

The main concern of pregnancy of unknown location is that the person could have an ectopic pregnancy.

Offer expectant management (instead of referring immediately) if ALL the following apply (low risk of ectopic pregnancy):

• <6 weeks of gestation
• PAINLESS bleeding
• No risk factors (e.g. previous ectopic pregnancy)

Expectant management involves:

1. Safety netting – to return if bleeding continues or pain develops
2. Repeat urine pregnancy test after 7-10 days, and return if +ve

*A normal early intrauterine pregnancy typically roughly doubles its hCG level every 48 hours, which corresponds approximately to a >63% rise over 48 hours. This can be a useful simplified way to remember the threshold.

Serial hCG trends after 48 hours are NOT diagnostic on their own. They are simply used to guide triage, risk stratification, and further investigation.