Having a PUL… so scared please advice/experiences

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Hello, I’m concerned that I might be having an ectopic pregnancy.

I had a positive test confirmed with a blood test on Tuesday, May 28. By Tuesday, June 4, I had light spotting when wiping with toilet paper. I went to the ER for an ultrasound, and my doctor said nothing was visible because it was too early. He prescribed progesterone and complete rest. At that time, my HCG level was 423.

I never had any more bleeding.

By Monday, June 10, my HCG level was 2,409.

On Thursday, June 13, my level rose to 4,335, and the ultrasound did not show a gestational sac, but nothing outside the uterus indicated ectopic either. My doctor advised me to wait a week and measure the HCG levels again and take another ultrasound.

However, I went ahead today and did another HCG test, and it rose to 6,808.

I am supposed to be 6 weeks pregnant, but maybe it is 5 weeks based on the HCG levels.

Has anyone been through this situation? What do you think?

Thank you very much.

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Dear Anajotta,

I am so sorry to hear of the worrying time you are going through. Not knowing what is happening to our bodies can be extremely overwhelming and you have friends here who understand.

It is important to understand that Pregnancy of unknown location - (PUL) is not a diagnosis; it is a label given until the final location of the pregnancy can be identified with certainty. In the event of a PUL, blood will be taken to measure serum progesterone and hCG and the hCG test repeated 48 hours later. The doctors would also want to repeat the scan. Until the location of the pregnancy is known definitively or the serum hormone levels have decreased to below pregnancy levels, there is a risk of complications associated with an as yet undiagnosed ectopic pregnancy.

Whilst I do not wish to alarm you, for every 100 pregnancies labelled as a PUL about 10 will subsequently be found to be ectopic; but not all of these will need treatment. If treatment is required, (methotraxate injection or surgery) this will depend on the results of blood tests and scans and I would discuss this further with your doctor.

It will be important to attend for your scan and any further blood tests organised, so your doctors can see a trend.

Although I do not wish to alarm you, whilst you are having investigations, I do need to remind you to seek urgent medical advice with any worsening pain or you develop bleeding, shoulder too pain of feel dizzy and unwell. We would a!so gently remind you to not undertake any strenuous exercise or lifting or housework.

I am sorry that I cannot provide you with more precise details but I hope all becomes much clearer over the forthcoming blood tests and scans. We are here for you for as long as you need,

Sending much love,

Karen x

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Hi there,

I had a PUL, but went down the ectopic route. I was bleeding and my numbers weren’t doubling or getting close to doubling… they were rising though. I personally along with doctors advice decided to call it as it was more than likely ectopic and if we waited another 1-2 weeks if it was in my tubes I risked rupture.

Part of me regrets not waiting to find out if it was in the uterus, but my it sounds like my pregnancy wasn’t going to be viable with my numbers. My numbers never reached over 450.

I would go with medical advice and see what they say. I didn’t wait because it was the advice given and I was in hospital every other day with serve cramping and blood clots.