Serial hCG measurements are therefore used, not to determine the location of the pregnancy, but to predict viability of the pregnancy. The current clinical pathway involves patients being seen in secondary care and having a blood sample sent to the laboratory. The change in hCG over 48 hours gives an indication as to whether the pregnancy is likely to be ongoing (intrauterine or ectopic), or whether it is more likely to be a failing pregnancy (either intrauterine or ectopic). The use of serial quantitative human chorionic gonadotropin (hCG) measurements is a mainstay of practice in Early Pregnancy Assessment Units (EPAUs) to aid in the management of these patients. Its incidence varies between 11 and live births in developed countries (3-5). The main clinical concern in cases where the pregnancy location has not been determined is whether there is an ectopic pregnancy, a potentially life threatening condition. The aim of subsequent investigations is to distinguish between these outcomes. The possible clinical outcomes of a PUL are: In up to 42% of cases no intrauterine pregnancy is seen on scan (and no ectopic pregnancy is identified) and this is known as a ‘pregnancy of unknown location’ (PUL) (2).
The first line of investigation for these women is an ultrasound scan to determine the location and the viability of the pregnancy (1). This reduces the pressure on the NHS as the treatment is quicker and often means the patient doesn’t have to be transferred to ED for quicker diagnosis.In pregnant patients presenting to Primary Care or to an Early Pregnancy Assessment Unit with bleeding and pain, what is the accuracy and utility of a point-of-care quantitative hCG test compared to standard laboratory measurement?īackground, Current Practice and Advantages over Existing Technology:īleeding and pain in early pregnancy are very common presentations to Primary Care, Emergency Departments and to specialist Early Pregnancy Assessment Units. The POC devices are decreasing the time to diagnose illnesses and the patients are getting the correct treatment more quickly. The benefit of avoiding emergency admissions may, therefore, be particularly high among people with a need for social care, from the perspective of both the patient and the NHS. The study suggests that once admitted, people with a need for social care often experience long stays in hospital, which may increase their risk of experiencing an event with an adverse health impact, such as an infection. If the patients are managed efficiently with the quick diagnosis at the community hospital, it helps in the reduced patient referrals to the ED. POC for both U&Es and CRP was shown to help in better patient management at the Wokingham Community Hospital leading to improved patient prognosis. With the implementation of the POC in the care pathway over a three-month period there was a reduction by 83% of ED referrals, with only five patient referrals needed. When the devices were not in use there were a minimum of 30 patients referred to ED. The total cost saving from the POC devices was ~£10,000 for a three-month period. During the three months that the study took place there was a significant reduction in patient referrals to ED. The result of the analysis suggests that the implementation of the POC devices in the community care pathway results in better patient management and cost savings.
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