Healthcare experiences and needs of patients with pregnancy of unknown location: a qualitative study

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 presented with bleeding or abdominopelvic pain to the OB/GYN office or emergency department and were found to have 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. 60% (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.

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.