Pregnancy of unknown location which was discovered to be an intra mural pregnancy at the previous uterine perforation site

A 35-year-old obese (BMI 35) woman presented to the antenatal clinic with a positive pregnancy test at a period of amenorrhea of six weeks. She was initially managed according to the Pregnancy of Unknown Location (PUL) care pathway. However, she presented with throbbing abdominal pain and required an emergency laparoscopy which revealed an intramural pregnancy at the site of a previous uterine perforation. The ectopic site was successfully excised laparoscopically. A detailed history, good knowledge of various rare presentations and the skills to make tailor-made decisions when dealing with PUL are crucial to avoid complications. Caregivers evaluating patients presenting with PUL should be well equipped to handle challenging cases such as these.