Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
[Preprint]. 2025 Jun 10:rs.3.rs-6735016.
doi: 10.21203/rs.3.rs-6735016/v1.

Healthcare Experiences and Needs of Patients with Pregnancy of Unknown Location: A Qualitative Study

Kavita Vinekar  1 , Zahava Shimshi  1 , Amanda Doty  1 , Samantha Kolowrat  1 , Rebecca Mercier  1 , Agatha Berger  1 , Kristin Rising  1
Affiliations

Healthcare Experiences and Needs of Patients with Pregnancy of Unknown Location: A Qualitative Study

Kavita Vinekar et al. Res Sq. .

Abstract

Background: 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.

Methods: 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.

Results: 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: provider communication, care environment and timely access to necessary services. 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.

Conclusions: 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.

Keywords: early pregnancy; first trimester bleeding; pregnancy complications; pregnancy loss; pregnancy of unknown location.

PubMed Disclaimer

Conflict of interest statement

Dr. Kristin Rising reports research grant funding from Abbott Diagnostics, DermTech, MeMed, Prenosis, Siemens Healthcare Diagnostics, PROCOVAXED (funded by NIAID 1R01AI166967), and PREVENT (funded by CDC U01CK00048) outside the submitted work. Dr. Rebecca Mercier reports research grant funding from Covis Pharma outside the submitted work. The other authors report no conflicts of interest.

Similar articles

See all similar articles

References

    1. Hasan R, Baird DD, Herring AH, Olshan AF, Jonsson Funk ML, Hartmann KE. Patterns and Predictors of Vaginal Bleeding in the First Trimester of Pregnancy. Ann Epidemiol [Internet]. 2010. Jul [cited 2023 Mar 7];20(7):524–31. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1047279710000293 - PMC - PubMed
    1. Rovner P, Stickrath E, Alston M, Lund K. An Early Pregnancy Unit in the United States: An Effective Method for Evaluating First-Trimester Pregnancy Complications. J Ultrasound Med Off J Am Inst Ultrasound Med. 2018. Jun;37(6):1533–8. - PubMed
    1. VanArendonk SH, Rockhill K, Stickrath EH, Alston MJ. Evaluation of Early Pregnancy Concerns in an Early Pregnancy Unit Compared With an Emergency Department. Obstet Gynecol. 2020. Nov;136(5):995–1000. - PubMed
    1. Pinnaduwage L, Honeyford J, Lackie E, Tunde-Byass M. The Sustained Value of an Early Pregnancy Assessment Clinic in the Management of Early Pregnancy Complications: A 10-Year Retrospective Study. J Obstet Gynaecol Can [Internet]. 2018. Aug [cited 2021 Dec 6];40(8):1017–23. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1701216317309118 - PMC - PubMed
    1. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011–2013. Obstet Gynecol [Internet]. 2017. Aug [cited 2023 Feb 2];130(2):366–73. Available from: https://journals.lww.com/00006250-201708000-00015 - PMC - PubMed

Publication types

LinkOut - more resources