PUL - ‘Pregnancy Of Unknown Location’ Advice (7 Weeks)

[JourneyToParenthood]

Hi. I’m currently 7 weeks pregnant with confirmed PUL. Have been spotting since 23/12 and my pregnancy test has never got darker than a faint ish line; so I just knew things weren’t right.

I went for my first scan at EPU 11/01 and HCG was 250, progesterone was 9. The nurse confirmed she could see ‘some free fluid’ on the left fallopian tube but it could be left over from ovulation. No pain when she moved the probe near my ovaries. On that day, I started bleeding more like a period. No cramping or pain. This bleeding has continued since but it’s pain free and no clots. It’s heavy enough to need a pad but not like a heavy period.

Went back again on 13/01 and had bloods and internal scan again. Bloods came back and they confirmed the levels hadn’t changed much. Their equations said that it was 41% chance of ectopic (they class this as high), 57% miscarriage, and 7% uterine pregnancy.

I’m due back again tomorrow 14/01 to repeat the scans and bloods. The continuous testing and waiting for rupture signs in the meantime is spiralling my anxiety. What should my options be at this point? I guess it’s not a confirmed ectopic, so I can’t push for an injection? Does it sound like I am miscarrying as I am bleeding even though I have no cramps?

Appreciate your thoughts, advice or experiences. Thank you.

Also at this point should something be visible in my tube if it’s developing there?

or perhaps nothing ever really developed in the first place so I have nothing to visibly ‘lose’ in my womb hence the low HCG 😵‍💫

so confused and panicky now

I was told that an ectopic growing in your tubes / being close to rupture you wouldn't be able to stand the pain when they scanned or when anywhere near your ovaries / tubes. I would take comfort in the fact they can't see anything and you can't feel anything. It sounds like a miscarriage that your body is slowly sorting itself out
I've had exactly this and it took weeks and weeks and weeks of scans and bloods to monitor my HCG dropping. They couldn't call it an eptopic it was always referred to as a PUL. My bleeding didn't really change it sort of was just consistently spotting until I had a slightly heavier bleed and then my HCG was back to 2. I felt pretty much like you've just said - nothing had really developed and it took a while for things to flush themselves out - it was a frustratingly anxious horrible time where I was constantly preying for a lower number every time I went back. Do you know what your HCG is? Mine never went over about 150 so low enough for nothing much to have developed. It was just a painfully slow decline. So sorry you're going through this. I took some time off after this but my next pregnancy went to term xxxxx good luck zxxxxx

Thank you for taking the time to reply. I really hope that this is what is happening with me too. I never thought I would say it but I am praying for a normal miscarriage.

My HCG on 11th was 250, I didn’t ask the figure yesterday (although I assume it was the same from their equation) but I will be sure to ask what it is tomorrow. I am taking all the positives that I can but honestly the waiting is totally terrifying me. Every little pain I feel I am second guessing. I don’t want to venture too far from a hospital either. I don’t think I could do this for weeks so fair play to you for going through that. What an anxious and horrible time it must of been for you xx

I think (and I'm sure you can Google) your HCG has to be a certain number for a sac to develop and I think it's much much much over 250 I hope that helps in terms of worrying about rupture. At that HCG it is probably things thickening up and that's about it.
You might hear the words expectant management when you go back which it sounds like what they are doing which is watching and waiting to see what happens without offering any medication or surgery. In some ways thats better because it's kinder on your body but it's also mentally really tough when you just want things to come to a close so you can try again.

When I had my ectopic I bled so bleeding doesn’t rule it out - however I was also in a lot of pain in a really specific location so the fact you’re not in pain is reassuring.
Does sound like an early miscarriage that your body is sorting out but it doesn’t make the waiting any easier. I hope hospital goes well tomorrow 🩷

Currently going through a miscarriage but
due to bleeding was in EPAU. My hcg level was 4000 plus and they said that was high enough to be able to see something but only just in a scan.

I’m so sorry you’re going through this. I’ve recently went through similar. They’ll want to see your HCG going down ✨🙏 xx

Hi all.

thank you for your kind and helpful responses. I am hoping my HCG has decreased considerably today but I will find out this evening.

I have been googling, not always helpful, but I have heard of people having MVP to remove pregnancy tissue from the uterus manually to try and decrease HCG levels. Is this likely to be an option for me? I will of course ask at my appointment too.

In the scans they have mentioned that my lining is very thick.

Thanks.

I had a tubal ectopic and it wasn't very painful at all, even when it ruptured. My shoulder was the painful bit at rupture and even then, it was mild pain.

OP - my ectopic was diagnosed at my first scan when I was 7+2 and it was very visible. I had been bleeding for 3 days and when they scanned me my uterine lining was like that of someone who wasn't pregnant. My HCG levels were around 400 from memory I think. It ruptured at 7+3 in the evening and was removed at 7+4. When they assessed me at A&E my HCG was increasing and at the second scan the pregnancy had visibly grown.

Sometimes an ectopic can self resolve I.e. your body miscarries it so to speak. It may be that is happening to you. You can also ask EPU what they think your risk of rupture is and hopefully it is very low if your HCG is low and decreasing.

Hi All.

A rupture certainly sounds very scary. I am not coping well with the wait and see method.

I have been admitted to hospital this afternoon after visible pregnancy in my right tube and free fluid (assume this means blood) on that side too. Physically I feel fine and my observations are also fine. I think she was a little shocked that I couldn’t feel any pain.

because of the bleeding I don’t qualify for the injection. It’s likely I will need to go to theatre to get the tube removed now unfortunately. They have given me the option of ‘wait and see’ but seeing as there is clearly a pregnancy in the tube, already blood visible, I think I would be a bit mad to wait any longer? I don’t cope well with uncertainty, the last few days have been extremely tough for me.

I am told that things still are positive from a conception front after surgery with one tube. I pray that is the case for me now.

I had an ectopic pregnancy on my ovary - very rare but can happen so just wanted to give you another scenario in that it may not be in your fallopian tubes. Upside was that it didn't require any treatment or surgery and caused no ill effects. Just had to wait for the bleeding to stop and for a negative pregnancy test to try again and was pregnant again within a few months!

Wow I did not know this could happen. I am sure you are very relieved of the outcome. Unfortunately mine is now visible in the right fallopian tube.

So sorry you’re going through this @JourneyToParenthood, wishing you a speedy recovery xx

I’m so sorry, I hope your surgery goes well and wishing you the very best for the future. Take it easy and if you didn’t know there’s a specific ectopic pregnancy charity which is super useful.

Sorry to hear that, Journey. Don't want to read and run without saying - I'm beyond the childbearing years now and during them knew several women who had ectopic pregnancies and went on to have multiple successful ones. Of course they were extra-anxious, but it worked out fine. Wishing you the same.

Sorry to hear that OP, mine was also the right tube. I hope it all goes well for you. I found the Ectopic Pregnancy Trust really helpful after my surgery. You can arrange a call with someone who has also been through an ectopic pregnancy and they also have lots of information and a forum.

Thank you all. I have been on the Ectopic Pregnancy Trust site and I am sure I will find their resources extremely helpful over the next few weeks as I navigate through this.

I had surgery this morning to remove the right tube. Waiting for a debrief from a doctor to find out if it had ruptured etc. but feeling reassured in my decision to have the surgery and a lot calmer this evening than I have been in weeks 🙏🏻

Sending you love and strength for your recovery xx

I was surprised how much calmer I felt post surgery, I think it was the sheer relief of having removed the danger.

Am glad you have got through the surgery. Take things easy. I only saw many months after my surgery but my EPU could arrange specialist counselling (I found the leaflet they gave me several days pre surgery when the ectopic was initially found). It's worth asking your hospital if they have similar in case you feel like you'd benefit in the future.

Sending you lots of strength for a speedy recovery xx