Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation

Figures & data

Table 1. Sampling frame characteristics and participant demographics.

				Total (n = 38)
Pregnancy outcome
Ongoing (live birth)				17
Miscarriage				15
Pregnancy of unknown location (PUL)				2
Ectopic pregnancy				2
Molar pregnancy				1
Termination of pregnancy (ToP)				1
EPAU configuration
Strata	Weekend opening	Consultant present	Volume of attendances
I	No	No	<2500	10
II	Yes	No	<2500	4
III	No	Yes	<2500	5
IV	Yes	Yes	<2500	1
V	No	No	≥2500	4
VI	Yes	No	≥2500	6
VII	No	Yes	≥2500	4
VIII	Yes	Yes	≥2500	4
Geographical location
East Midlands and The East of England				5
London				6
North West, Yorkshire, and The Humber				5
Scotland and The North East				7
South East				7
West Midlands, Wales, and South West				8
Index of multiple deprivation (decile)
1 (most deprived)				5
2				2
3				5
4				2
5				3
6				2
7				4
8				3
9				4
10 (least deprived)				5
Data not provided/missing				3
Short Assessment of Patient Satisfaction (SAPS) Score [18]
High (≥26)				18
Low (≤25)				20

Figure 1. Emotional typologies.

Table 2. Emotional typologies and participant exemplars.

Emotional typology	Mapped clinical care pathway	Participants^a	Exemplars
Anxious presentation	Rapid Positive Diagnosis, No Intervention Required, Positive Outcome	2, 4, 5, 7, 10, 20, 21^b, 22, 23, 25, 28, 31, 32, 34, 35	Participant 34: Pregnant for the first time and started to worry when she experienced spotting whilst on holiday. She contacted the EPAU who booked her in for a scan the next day. Her anxiety was sustained until the baby’s heartbeat was revealed on the scan, which then reassured her that the pregnancy was still ongoing. She then went onto have a livebirth, not requiring the services of the EPAU again.
Sustained anxiety due to diagnostic uncertainty	Delayed Positive Diagnosis, No Intervention Required, Positive Outcome	29, 33, 37, 39	Participant 39: Having experienced bleeding in a previous pregnancy, this participant again experienced bleeding and some cramping in the first few weeks of this pregnancy, causing her to worry. She arranged an appointment at the EPAU via her GP and was booked in for a scan. The sonographer explained that there was a foetal sack, but no heartbeat and so a viable pregnancy could not be confirmed. She was asked to come back after ten days for another scan, where the foetal heartbeat was detected and subsequently went on to have a live birth.
Anxious-Upset	Rapid Negative Diagnosis, No Intervention Required, Negative Outcome	1, 8, 11, 12, 18, 19, 38	Participant 19: Presented to the EPAU with cramping and bleeding and had a miscarriage confirmed. EPAU staff decided it was better to let the miscarriage progress naturally, however she later self-referred to EPAU as was feeling unwell with the miscarriage. No further action was taken nor did she have any medical or surgical intervention, returning home to complete the miscarriage naturally. Participant 38: Noticing some spotting early into the pregnancy, which later became heavier bleeding, she was referred to the EPAU. She was seen the next day, where scans confirmed she had lost the pregnancy via a complete natural miscarriage.
Anxious-Upset after Diagnostic Uncertainty	Delayed Negative Diagnosis, No Intervention Required, Negative Outcome	14, 15, 17, 24, 27	Participant 14: After experiencing some bleeding, she attended the EPAU. A miscarriage was presumed on the first visit, but Iris was requested to come back to confirm, which she did and as the miscarriage had completed naturally, there was no need for any intervention. Participant 17: Attended EPAU, as had started to bleed. EPAU suspected miscarriage, but due to inconclusive scan asked her to return after 48 h to do more blood tests and confirm the miscarriage. Participant 27: Recently stopped contraception and fell pregnant for the first time. She began spotting and called the EPAU who advised her to monitor the spotting and to call back if her symptoms worsened or she was worried. Within two days, the spotting turned to bleeding and she booked an EPAU appointment, where a foetal pole, but not a heartbeat was seen on the scan. She was advised it might be too early to detect the heartbeat and asked her to return in two weeks. Within a few days she began to miscarry naturally at home and returned to the EPAU. The EPAU was confident the miscarriage would complete naturally, but booked her in for a further two appointments, the first of which led to confirmation the miscarriage was complete and she was discharged.
Anxious-Upset with Procedural Uncertainty	Rapid Negative Diagnosis, Intervention Required, Negative Outcome	6, 9, 16, 21^b, 30	Participant 9: Approximately 9-weeks into her pregnancy, she awoke with severe abdominal pain followed by bleeding. She suspected she was miscarrying and, having had previously used EPAU services, called to arrange an appointment. At the EPAU she was scanned, resulting in an ectopic pregnancy diagnosis. She was then rushed onto the hospital ward to surgically remove the rupturing ectopic.
Anxious with Sustained Uncertainty	Delayed Negative Diagnosis, Intervention Required, Negative Outcome	3, 13, 26	Participant 13: Experienced some bleeding early in her pregnancy and was referred to the EPAU by her GP. The first scan came back inconclusive. On her second visit, she was told the sack had grown, but there was no still evidence of a viable pregnancy. A third scan showed what clinicians believed to be evidence of a pregnancy, and she was asked to return after a further week. Finally, it was confirmed that there was no evidence of a viable pregnancy and that she had a molar pregnancy and would need immediate surgery.

^aParticipant 36 is missing from the dataset due to participant’s data being excluded from the analysis.

^bParticipant 21 appears twice—in ‘Anxious Presentation’ and ‘Anxious-Upset with Procedural Uncertainty’, as participant presented to EPAU twice and received two different diagnoses, the final of which resulted in loss.

Hawthorne G, Sansoni J, Hayes L, et al. Measuring patient satisfaction with health care treatment using the short assessment of patient satisfaction measure delivered superior and robust satisfaction estimates. J Clin Epidemiol. 2014;67(5):527–537.

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Data availability statement

The datasets generated and/or analyzed during the current study are not publicly available due to the sensitive nature of these data but are available from the corresponding author upon reasonable request.