Psychological Impact of Pregnancy of Unknown Location

Study Overview
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Brief Summary
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To assess the psychological impact of pregnancy of unknown location (PUL) classification pending a final diagnosis.

Detailed Description
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PUL is a syndrome of early pregnancy composed of a positive urine pregnancy test without the visualisation of a pregnancy on trans-vaginal ultrasound (TVUS). The current method for risk stratifying a PUL is via serum BhCG levels at the time of identification of PUL and after 48 hours, in order to ascertain the viability of the pregnancy. Patients and their partners need to wait for this result before a management plan can be adopted, taking at least 2-3 hours. There is a clear need for the patient care pathway to evolve in order to aid and improve the management of women classified with a PUL. By using point-of-care BhCG testing, the investigators hope to shorten the time to management. The investigators therefore propose that shortening the time interval would reduce psychological morbidity. This is a prospective cohort observational study.

Official Title
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Psychological Impact of Pregnancy of Unknown Location

Conditions
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Pregnancy of Unknown Location, Ectopic Pregnancy, Anxiety

Intervention / Treatment
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* Other: The Hospital and Anxiety Depression Scale
* Other: Point of care testing (POCT)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Pregnant women attending the Early Pregnancy Unit in the first trimester (up to 14 weeks gestation) with a pregnancy of unknown who are over 18 years old and are able to give consent. Exclusion Criteria: Presence diagnosed with cancer The presence of an acute medical condition Patients/partners aged less than 18 years Patients or partners who cannot give fully informed study consent (language or learning impairment) Presence of a viable intrauterine pregnancy, ectopic pregnancy and miscarriage.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patient: point of care (POC) result not shared<br>Patients in this phase of the study will not be provided with the POC BhCG result. They will await the laboratory result. Simultaneously we will ascertain reliability of POC in clinical practice during this time. | Other: The Hospital and Anxiety Depression Scale<br>* Patients and partners will be asked to complete the questionnaire at three time points: 1) On classification of PUL at time zero once blood is taken, 2) at the 48-hour time point after blood is taken (if 48 hour bloods are required for the patient); and 3) after definitive diagnosis and management.<br>Other: Point of care testing (POCT)<br>* Patients will have 1ml sample of blood taken for POCT at two time points: 1) On classification of PUL at time zero at the same time as when routine blood samples taken; and 2) at the 48-hour time point at the same time as when routine blood samples are taken (if 48 hour bloods are required).<br>|
| Partner: point of care (POC) result not shared<br>Partners in this phase of the study will not be informed of the POC BhCG result. They will await the laboratory result to be provided to the patient. Simultaneously we will ascertain reliability of POC in clinical practice during this time. | Other: The Hospital and Anxiety Depression Scale<br>* Patients and partners will be asked to complete the questionnaire at three time points: 1) On classification of PUL at time zero once blood is taken, 2) at the 48-hour time point after blood is taken (if 48 hour bloods are required for the patient); and 3) after definitive diagnosis and management.<br>Other: Point of care testing (POCT)<br>* Patients will have 1ml sample of blood taken for POCT at two time points: 1) On classification of PUL at time zero at the same time as when routine blood samples taken; and 2) at the 48-hour time point at the same time as when routine blood samples are taken (if 48 hour bloods are required).<br>|
| Patient: point of care (POC) result shared<br>Patients in this phase will be informed of the POC test result, which will reduce the time to which they receive the result. Prior to transfer to this phase, correlation between POC and laboratory BhCG levels will be calculated in order to confirm its reliability by creating a correlation curve using the data. | Other: The Hospital and Anxiety Depression Scale<br>* Patients and partners will be asked to complete the questionnaire at three time points: 1) On classification of PUL at time zero once blood is taken, 2) at the 48-hour time point after blood is taken (if 48 hour bloods are required for the patient); and 3) after definitive diagnosis and management.<br>Other: Point of care testing (POCT)<br>* Patients will have 1ml sample of blood taken for POCT at two time points: 1) On classification of PUL at time zero at the same time as when routine blood samples taken; and 2) at the 48-hour time point at the same time as when routine blood samples are taken (if 48 hour bloods are required).<br>|
| Partner: point of care (POC) result shared<br>Partners in this phase will be informed of the POC test result with the patient, which will reduce the time to which they receive the result. Prior to transfer to this phase, correlation between POC and laboratory BhCG levels will be calculated in order to confirm its reliability by creating a correlation curve using the data. | Other: The Hospital and Anxiety Depression Scale<br>* Patients and partners will be asked to complete the questionnaire at three time points: 1) On classification of PUL at time zero once blood is taken, 2) at the 48-hour time point after blood is taken (if 48 hour bloods are required for the patient); and 3) after definitive diagnosis and management.<br>Other: Point of care testing (POCT)<br>* Patients will have 1ml sample of blood taken for POCT at two time points: 1) On classification of PUL at time zero at the same time as when routine blood samples taken; and 2) at the 48-hour time point at the same time as when routine blood samples are taken (if 48 hour bloods are required).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychological morbidity | Psychological morbidity will be assessed using the Hospital Anxiety and Depression Scale on time of PUL classification, 48 hours from PUL classification and following final diagnosis and management. For both Anxiety and Depression, participants can score anywhere from 0 to 21. Score of 11 and above indicate moderate to severe anxiety and depression. | 18 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Pregnancy of unknown location, PUL, Ectopic pregnancy, Anxiety