Gynaecology Department Pregnancy of unknown location Information for patients, relatives and carers This information sheet is for women who have a pregnancy of unknown location (PUL). It explains what a PUL is and what tests you will need. What happens next? What is a PUL?  The nurse or doctor will take some blood to check your pregnancy hormone (βHCG) and occasionally progesterone levels. βHCG is the same hormone that makes your urine pregnancy test positive and we can measure the level in your blood. Progesterone level is usually high in a normal pregnancy. The blood tests will help to guide us in your follow up.  To help us find out where the pregnancy is developing we need to look at the pregnancy hormone level and how it is changing. A pregnancy of unknown location (PUL) is when you have a positive pregnancy test but we have been unable to see the pregnancy on ultrasound scan. What does it mean?  You will need a repeat blood test (βHCG) after 48 hours in order to compare the two levels and look at the trend. In a normal pregnancy βHCG approximately doubles every 48 hours. There are three possible reasons for this: 1. The pregnancy is too early to be seen on scan – commercially available pregnancy testing kits are now extremely sensitive and can sometimes detect the pregnancy hormone just a few days after conception. However a pregnancy may not be seen on ultrasound until approximately five weeks after your last period. Therefore, a pregnancy may be developing normally but is too early to be seen on ultrasound scan. This is also more likely if you are unsure of your last period date or have irregular periods.  Following this you may be booked for another ultrasound, asked to have another βHCG or asked to come to the ward for review. A member of staff will contact you with the results and advise accordingly. What if I get pain or bleeding? If you get severe pain, pain across the shoulders, diarrhoea, fainting or feel unwell, then you should contact the ward for advice. You may call us at any time during your treatment if you are concerned or have any questions. 2. An early miscarriage has occurred – if you had heavy bleeding, it could be that an early miscarriage has occurred. Pregnancy tests often stay positive for a couple of weeks after a miscarriage. 3. The pregnancy is outside the womb (an ectopic pregnancy) – this is the least likely possibility but an ectopic pregnancy is not a normally developing pregnancy. Ectopic pregnancies most commonly occur in the fallopian tubes. It is important that we identify an ectopic pregnancy as it is potentially life threatening, so we will be monitoring your case closely. How long will I be under the care of the hospital? This will be until we have confirmed a diagnosis or treated you (if required). Some women will need a longer follow‐up and this may include further blood tests. If your pregnancy hormones are falling, we may ask you to repeat your home pregnancy test after a period of time. 2 If your pregnancy test remains positive at this stage then you should contact us to arrange further follow‐up. Useful contact details Basingstoke and North Hampshire Hospital Early Pregnancy Assessment Unit 01256 312766 (Monday to Friday, 9am to 8pm) Is there anything that I should or should not do?  You should be able to do most things normally until we confirm your diagnosis.  We suggest that you do not travel out of the country.  You should avoid strenuous exercise and sexual intercourse. Women’s Health Unit 01256 313583 or 01256 313584 (24 hours) Royal Hampshire County Hospital Anthony Letchworth Ward 01962 824484 (24 hours) We understand that this is a very difficult time for you, so please do not hesitate to contact us if you need our help or support during your course of treatment. Further information Miscarriage Association 01924 200799 www.miscarriage.association.org.uk The Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/files/rcog‐ corp/Early%20Miscarriage.pdf www.hampshirehospitals.nhs.uk Sister Pauline Bawden, Early Pregnancy Assessment Unit, HHFT Consultants Miss Amara Sohail and Mrs Renee Behrens, HHFT June 2014 Review June 2016 FCS/ 123/ 2014 © Hampshire Hospitals NHS Foundation Trust 3