Vinekar Kavita, Shimshi Zahava, Doty Amanda, Kolowrat Samantha, Mercier Rebecca, Berger Agatha, Rising Kristin
Thomas Jefferson University.
Res Sq. 2025 Jun 10:rs.3.rs-6735016. doi: 10.21203/rs.3.rs-6735016/v1.
Patients presenting with bleeding or pelvic pain in early pregnancy are commonly found to have pregnancies of unknown location (PUL), with no sonographic findings of intrauterine nor ectopic pregnancy. We aimed to explore healthcare experiences and needs of patients presenting with PUL.
This was a qualitative study using semi-structured interviews to explore healthcare experiences among patients with PUL. Patients were eligible if they had a PUL followed in an electronic health record tracking list; had an initial human chorionic gonadotropin (hCG) level of > 5 mIU/mL; spoke English; and were 18 years or older. Quasi-inductive directed content analysis was performed using NVivo 13.
We conducted 20 qualitative interviews from November 2023 to March 2024. Sixty percent (n = 12) of participants identified as non-Hispanic Black, all identified as cis-gendered women, and the mean age was 30.6 years. All participants were insured and most (65%) had public insurance. Analysis resulted in findings around three general domains of PUL healthcare experiences: . Participants generally appreciated a resident-staffed phone line for discussing questions and results. They noted successes and gaps in provider communication of uncertain diagnoses, mental health resources, and optimization of care environment, perhaps in a dedicated pregnancy emergency care unit.
In facing the diagnostic uncertainty of PUL, patients voiced needs for more direct communication, more timely care and support resources, and more targeted pregnancy-specific emergency care. Our findings reveal opportunities for improvement in provider training and healthcare organizational structuring to better meet patient needs.
早期妊娠出现出血或盆腔疼痛的患者通常被发现怀有妊娠位置不明（PUL）的情况，超声检查未发现宫内或异位妊娠的迹象。我们旨在探讨PUL患者的医疗经历和需求。
这是一项定性研究，采用半结构化访谈来探讨PUL患者的医疗经历。如果患者在电子健康记录跟踪列表中有PUL记录；初始人绒毛膜促性腺激素（hCG）水平>5 mIU/mL；会说英语；年龄在18岁及以上，则符合入选条件。使用NVivo 13进行准归纳定向内容分析。
我们在2023年11月至2024年3月期间进行了20次定性访谈。60%（n = 12）的参与者为非西班牙裔黑人，均为顺性别女性，平均年龄为30.6岁。所有参与者都有保险，大多数（65%）有公共保险。分析得出了围绕PUL医疗经历三个总体领域的结果：参与者普遍赞赏有住院医生值班的电话线用于讨论问题和结果。他们指出了在提供者沟通不确定诊断、心理健康资源以及优化护理环境（可能在专门的妊娠急诊护理单元）方面的成功之处和差距。
面对PUL的诊断不确定性，患者表达了对更直接沟通、更及时的护理和支持资源以及更有针对性的妊娠特异性急诊护理的需求。我们的研究结果揭示了在提供者培训和医疗组织结构方面进行改进以更好地满足患者需求的机会。
