Pregnancy of unknown location (PUL): a case report and review of literature

While most pregnancies are obviously within the uterus, Pregnancy of Unknown Location (PUL) is used to describe cases where, there is a positive pregnancy test but no sign of a pregnancy inside or outside the uterus, on transvaginal ultrasound or even at laparoscopy. We report a case of multigravida with history of disturbed tubal ectopic pregnancy in previous pregnancy presented with lower abdominal pain and spotting per vaginum following 6 weeks amenorrhoea. The patient was clinically stable with no evidence of intrauterine or extrauterine pregnancy in transvaginal sonography with serum beta human chorionic gonadotropin (beta-hCG) above descriminatory levels. Provisional diagnosis of Pregnancy of Unknown Location (PUL) was made and serial beta-hCG levels shows increasing levels. Endometrial curettage done with histopathology report showed product of conception following which there was a fall in serum beta-hCG. She was finally diagnosed as a case of silent miscarriage. Expectant management has been shown to be safe and effective in reducing the need for surgical intervention but does require close surveillance of patients who present with PUL