When combined, the reading of hormone levels in blood helps us to determine whether a miscarriage had already occurred or whether a pregnancy is still developing and further follow up scans are needed. We carry out a blood test to measure of hormones ß-hCG and progesterone. We have developed our own highly effective method for assessing women presenting with PUL. A small proportion women with PUL are diagnosed with ectopic pregnancy on follow up scans. Some women are not sure when they may have fallen pregnant and they may attend for the scan before pregnancy is large enough to show on ultrasound. It usually takes for a couple of weeks for pregnancy hormones to clear after miscarriage which explains why the pregnancy test is still positive. In most cases this is because miscarriage had happened before women attend for the scan. This is described as a pregnancy of unknown location (PUL). Sometimes pregnancy cannot be seen on the scan although the urine pregnancy test is positive. Our team is particularly well known for their expertise in the diagnosis and management of Caesarean scar ectopic pregnancy and we regularly see women with this condition who are referred to us from all parts of the UK and many European countries. We also have particular interest in the diagnosis and management of Caesarean scar pregnancy and other rare ectopic pregnancies such as cervical, interstitial and intramural pregnancy. The main risk of Caesarean scar pregnancy is severe bleeding from the uterus which can happen even when pregnancy is very early and can lead to a hysterectomy and loss of woman’s fertility. The diagnosis of Caesarean scar pregnancy is not always easy and it requires a high level of ultrasound skill. Women who had two or more Caesarean sections are at particularly high risk of developing these early pregnancy complications. This type of ectopic pregnancy occurs when a pregnancy implants into a hole in the uterine muscle caused by poor healing after previous Caesarean section. Our consultants have been in the forefront of research in the management of ectopic pregnancy for many years and have developed a diagnostic approach which helps more than a third of women with ectopic pregnancies to overcome the condition without needing surgery or medical treatment. In these cases, ultrasound helps to identify those women in whom ectopic pregnancy is likely to resolve naturally without causing harm. The majority of women with ectopic pregnancies present with mild symptoms, which do not require immediate operation. In some cases, an ectopic pregnancy may lead to serious internal bleeding and prompt, accurate diagnosis helps to avoid delays in referring women for emergency surgery. All our consultants are experts in the ultrasound diagnosis of ectopic pregnancy. Ultrasound is the only method which provides a reliable diagnosis of ectopic pregnancy prior to surgery. Women who fall pregnant whilst using coil for contraception and those who have had an ectopic pregnancy in the past are at particularly high risk of having an ectopic pregnancy. ![]() Risk factors for tubal ectopic pregnancy are history of pelvic infection, history of infertility and increased maternal age. The most common location of ectopic pregnancy is in the Fallopian tube, but they may occur anywhere in the pelvis. ![]() They are relatively rare and they occur in 1-2% of all pregnancies. Early pregnancy complications which are located outside the uterine cavity are described as ectopic pregnancies.
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