Pregnancy of unknown location

The development of highly sensitive and accurate human chorionic gonadotropin assays as well as the improvement of vaginal ultrasound have allowed for the early detection of pregnancy and have reduced the morbidity and mortality associated with ectopic gestations. One of the byproducts of this increased sensitivity is pregnancy of unknown location (PUL), a term which is used to describe pregnancy in a woman with a positive pregnancy test but no signs of intrauterine or extrauterine pregnancy. A PUL can include an early intrauterine pregnancy, a failing intrauterine/extrauterine pregnancy or ectopic pregnancy. Modern medical management has improved the diagnosis and treatment of early pregnancy and pregnancy loss. In the hemodynamically stable patient with PUL, expectant management has been shown to be safe and allows for confirmatory studies before proceeding with therapy.