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Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City spoke with Dr. Caroline Friedman regarding pregnancy of unknown location on Healthful Woman’s podcast. Read on to learn more about their discussion.

When healthcare professionals talk about pregnancy of an unknown location, they are referring to a specific time in a woman’s early pregnancy when it is too early to pinpoint the fetus on an ultrasound. A woman will know that she is pregnant, have a positive pregnancy test, and may even have some symptoms of pregnancy, but an ultrasound of the uterus is not yet showing visible signs of pregnancy.

Many women may have a positive pregnancy test but not show any symptoms, which can be normal if it is too early in the pregnancy. The only time this can be concerning is when there is potential for an ectopic pregnancy, or if the patient is having symptoms such as pain or bleeding.

What Can a Pregnancy of Unknown Location Present As?

Overall, there are three main outcomes with a pregnancy of an unknown location. “The most common thing that’s going on is an early normal pregnancy that is just too early to be seen on ultrasound,” said Dr. Friedman. “The next option is that it’s a pregnancy inside the uterus, but for whatever reason, it’s not developing normally. And so, it will turn into what we call a chemical pregnancy, or a miscarriage.” “The third option would be an ectopic pregnancy, which is a fertilized egg that implants somewhere outside of the uterus, whether it’s in a fallopian tube, which is most common, or sometimes even the ovary, or just outside of the pelvic organs in the abdomen.”

How Your Doctor Determines Next Steps

When a woman presents with a pregnancy of unknown location, there are certain tools and techniques that doctors can use to differentiate between those three options. First, your provider will obtain health information from you such as when your last period was, how long your cycles are, and if you conceived through intercourse or IVF. Your doctor ask you about symptoms such as bleeding or cramping.

Next, an ultrasound will take place. If nothing can be identified on the ultrasound, your doctor will generally recommend checking the pregnancy hormone level in your blood. This hormone is called beta-hCG and is secreted when you are pregnant. “It starts at zero and kind of builds itself up on a continuous basis in the case of a normal pregnancy,” explained Dr. Friedman. “There are specific values of HCG at which we should expect to see something in the uterus. If it’s below that value, we might not.” Using a combination of your history, ultrasound findings, and HCG levels, we can better determine what might be going on. Importantly, your doctor may have you repeat the hCG bloodwork after 48 hours to best understand how the levels are trending.

If your hCG levels are trending high but your doctor still does not see anything in your ultrasound, or the trend is abnormal, something may be abnormal. In these cases, it is important to follow up closely with your physician as ectopic pregnancies can be dangerous, as should be treated as soon as possible to ensure your health and safety.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!