Assessment of Pregnancy Desires for Patients With Pregnancy of Unknown Location Seen in the Emergency Department [ID 2683447

Abstract

INTRODUCTION: Desire for pregnancy should be centered in all discussions surrounding pregnancy management, including management of pregnancy of unknown location (PUL). Little is known about the evaluation of pregnancy desires for patients presenting to the emergency department (ED) found to have PUL. METHODS: We performed a retrospective cohort study of patients presenting to a tertiary-care ED with a positive pregnancy test and previously unconfirmed intrauterine pregnancy in the first trimester between January 2020 and December 2022. We excluded patients with chief complaints regarding known intrauterine pregnancy. The primary outcome was documentation of pregnancy desire by the ED provider. The secondary outcome was assessment of pregnancy desiredness by consulting gynecologic providers. Chi-squared and Fisher exact tests assessed for demographic variables. Institutional review board approval was obtained. RESULTS: Four hundred ninety-seven patients were included. Overall, only 105 (21.1%) of all patients and 12 (13.5%) patients with PUL were asked about pregnancy desiredness by the ED provider. While not statistically significant, patients with PUL had the lowest rate of being asked their pregnancy desires, compared to patients with confirmed intrauterine pregnancy (22.7%), ongoing miscarriage (28.1%), or ectopic/adnexal pathology (20.0%) (P=.15). Of those asked, 11 patients (10.5%) reported the pregnancy was undesired and 7 (6.7%) were unsure. There were no significant associations between asking pregnancy desires and age, race, ethnicity, parity, insurance, and language. For patients added to the beta book and followed by gynecology, 59.3% of patients were asked about their pregnancy desires. CONCLUSION: This study highlights gaps in early pregnancy evaluation and counseling, with only one in five patients asked their pregnancy desires. Patients with adnexal pathology and PUL had among the lowest rates of counseling, compared to those with ongoing miscarriage. This research suggests a missed opportunity for comprehensive pregnancy options counseling and management in the ED and the potential for improvement of care for patients with undesired PUL.