What is a Pregnancy of Unknown  Location (PUL)?

A woman is classified as having a PUL when she has a positive pregnancy test, with no signs of an intra or extra-uterine pregnancy on trans-vaginal ultrasound scan. PUL is a highly  distressing condition for mothers & families occurring in 8%-31% of pregnancies.  PUL carries a high risk for maternal mortality and foetal loss (e.g. ectopic pregnancy). 

Careful management promotes early diagnosis & reduces maternal mortality. Current management of PUL is variable often resulting in unnecessary healthcare visits with uncertainty regarding the final diagnosis.

About the Decision Support Tool (DST)

A NIHR CLAHRC NWL study developed a Decision Support Tool (DST) based on hormonal measurements,
validated in a cohort of 3,272 patients (negative predictive value of 99.2% and sensitivity of 97.2%).The Decision Support Tool (DST) aims to facilitate timely intervention for those in need and rapid reassurance for those at low risk, reducing unnecessary use of NHS resourcesThe DST is linked to a management protocol, which adjusts the number of follow-up appointments and diagnostic tests based on the risk of an adverse event.

The DST, developed using the latest evidence available to clinicians, is now routinely used in three hospital sites in NWL. The research programme continues to validate the tool and spread the intervention to other hospital sites outside NWL. The research programme continues to validate the tool and spread the intervention to other hospital sites.