Abstract：
Objective: To quantify proportions of loss to follow-up in patients presenting with a pregnancy of unknown location and explore patients\' perspectives on follow-up for pregnancy of unknown location. A pregnancy of unknown location is a scenario in which a patient has a positive pregnancy test but the pregnancy is not visualized on transvaginal ultrasound. Study Design: We conducted a retrospective cohort study of patients with pregnancy of unknown location who presented to an urban academic emergency department or complex family planning outpatient office. We sought to calculate the proportion of patients lost to follow-up, defined as inability to contact the patient within 2 weeks. We then conducted focus groups of patients diagnosed with a pregnancy of unknown location. We used thematic analysis to identify themes related to follow-up. Results: We reviewed 464 charts of patients diagnosed with pregnancy of unknown location. The median age in this cohort was 27 with most patients identifying as Black (80%, n = 370) and using public insurance (67%, n = 315). When looking at loss to follow-up rates, Black patients experienced loss to follow-up (20%, n = 72) more often than White patients (4%, n = 2; p = 0.003). Focus group participants had a mean age of 31.8+/-4.8, and the majority were of Black race (n = 16, 72.7%). Participants identified barriers to follow-up including the long duration of management, general inconvenience, and poor communication with their health care team. Participants felt a burden of responsibility to learn about their condition and to self-advocate for their follow-up and communication of results. Conclusions: These data indicate that Black patients are more likely to experience loss to follow-up compared with White patients during monitoring for pregnancy of unknown location. Patients identified many barriers to follow-up and felt that successful follow-up required substantial self-efficacy.
摘要：
目的：量化不明位置妊娠患者的随访损失比例，并探讨患者对不明位置妊娠随访的看法。未知位置的妊娠是其中患者具有阳性妊娠测试但在经阴道超声上不可见妊娠的情形。研究设计：我们进行了一项回顾性队列研究，对象是妊娠地点不明的患者，他们到城市学术急诊科或复杂的计划生育门诊就诊。我们试图计算失去随访的患者比例，定义为2周内无法联系患者。然后，我们对诊断为未知位置妊娠的患者进行了重点小组。我们使用主题分析来确定与后续行动相关的主题。结果：我们回顾了464例诊断为不明位置妊娠的患者的图表。该队列的中位年龄为27岁，大多数患者确定为Black（80％，n=370)，并使用公共保险(67%，n=315）。在查看后续率的损失时，黑人患者经历了随访失败(20%，n=72)比白人患者(4%，n=2;p=0.003)。焦点组参与者的平均年龄为31.8+/-4.8岁，大多数是黑人（n=16，72.7%）。与会者确定了后续行动的障碍，包括管理时间长，一般不便，和他们的医疗团队沟通不畅。与会者感到有责任了解他们的状况，并自我倡导他们的后续行动和成果交流。结论：这些数据表明，在监测未知位置的妊娠期间，与白人患者相比，黑人患者更有可能失去随访。患者发现了许多随访障碍，并认为成功的随访需要大量的自我效能。
