Document Type
Presentation
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Publication Date
6-28-2024
Abstract
Pregnancy of unknown location (PUL) occurs when a person tests positive for pregnancy, but the fetus cannot be located within the uterus during an ultrasound scan. It presents a complex clinical challenge characterized by significant diagnostic uncertainty, emotional distress for patients, and a potential delay in treatment. This condition requires thorough investigation to differentiate between various outcomes, including intrauterine pregnancy, ectopic pregnancy, or miscarriage. Despite the use of multiple blood tests and ultrasound examinations over a period of up to six weeks, uncertainty may persist, exacerbating emotional strain and undermining patient-provider relationships. This study aimed to delve into the lived experiences of patients with PUL through semi-structured interviews with 20 participants. The interviews explored a range of topics, including healthcare expectations, perceptions of care quality, and the influence of factors such as race, gender, religion, and pregnancy planning on their experiences. Applying the Andersen’s Behavioral Model facilitated identification of key areas for potential improvement in healthcare delivery and patient outcomes. Key findings underscored the profound emotional distress experienced by patients grappling with diagnostic uncertainty during PUL episodes. Participants emphasized the critical need for improved communication, transparent diagnostic processes, and enhanced support from healthcare providers. Specific recommendations emerged, including more effective addressing of patient concerns and streamlining emergency room procedures to minimize wait times. These insights suggest that adopting strategies informed by the Andersen’s Behavioral Model could enhance provider communication, improve triage processes in emergency settings, and ultimately elevate the quality of care for individuals navigating PUL. By addressing these aspects, healthcare systems may mitigate negative health outcomes, reduce emotional distress, and enhance overall patient satisfaction in managing PUL.
Lay Summary
About 25% of women may have bleeding or cramping in the early days of pregnancy, which often leads them to seek care at the emergency department or schedule a visit with their doctors. In some cases, despite have a positive pregnancy test, doctors are unable to find the pregnancy using ultrasound. This is called a pregnancy of unknown location (PUL).
It could be a normal pregnancy inside the uterus, a dangerous one outside, called an ectopic pregnancy, or a miscarriage. Ectopic pregnancies are serious and can lead to serious health problems, infertility and sometimes even death. In the United States, these cases are increasing, showing a need for better healthcare for pregnant people and care during PUL. In order to figure out what is going on, the patient needs to have their blood taken multiple times and get a follow up ultrasound scan. These tests take up to six weeks, which could be very time consuming and expensive for people. At the end, they might still not know exactly what happened. It is very emotionally difficult and can cause someone to lose trust in the healthcare system or their doctors. To figure out how we can improve this experience, we interviewed 20 patients who went through this. We focused on what people thought were the biggest concerns, if they were unable to get the care they needed, and what they wished happened differently. We also wanted to know their ideas on how we can improve the care and how we could make it less stressful and emotionally difficult for them. From the interviews, we learned patients value when doctors ask about if their pregnancy was planned and wanted, advise them on future ability to get pregnant, and be more compassionate about their situation. They also want clearer explanations about why this was happening and why they need to have more tests done. Another important finding was ideas to cut down on waiting times in the emergency room, as patients felt it caused more emotional stress and discomfort. These findings could be used to help improve patient experience surrounding pregnancy of unknown location.
Recommended Citation
Rubin Shimshi, Zahava, "PULSE: Pregnancy of Unknown Location: Study of Patient Experiences" (2024). Master of Public Health Capstone Presentations. Presentation 563.
https://jdc.jefferson.edu/mphcapstone_presentation/563
Language
English
Comments
Presentation: 5:36
Poster attached as supplemental file below