oA retrospective analysis was conducted on fifty patients who presented to Gynaecology A&E with a positive pregnancy test and underwent serum β-hCG testing between October and December 2024.

oCases were identified via patient records and electronic systems.  Data was anonymized and analyzed for adherence to PUL management guidelines.

oTotal of 50 patients underwent serum β-hCG testing over a 3-month audit period. 9 patients had β-hCG measured despite an intrauterine gestational sac (IUGS) on ultrasound.

oAmong 37 confirmed PUL cases, most resulted in miscarriage, with β-hCG tests performed on average, despite meeting miscarriage criteria after two measurements

oSix cases were viable pregnancies; however, 10% of these still received β-hCG tests beyond guideline recommendations.

oFor suboptimal β-hCG rises, follow-up testing often occurred in the emergency department instead of outpatient settings, potentially affecting care continuity

oAccording to NICE guideline NG126, initial management includes serial serum β-hCG measurements every 48 hours. A rise >63% suggests a likely intrauterine pregnancy; a fall >50% indicates a failing pregnancy. Suboptimal changes (<63% rise or <50% fall) require further review within 24 hours at an early pregnancy unit. TVUS is essential. If β-hCG exceeds 1,500 IU/L with no visible intrauterine pregnancy, a repeat scan in 7–14 days is advised.

oPersistent PUL with rising β-hCG should prompt ectopic pregnancy consideration and care escalation. Adhering to this algorithm improves diagnostic accuracy, reduces unnecessary testing, and supports early intervention in high-risk cases.

oThis audit found overuse in hCG testing and guideline adherence discrepancies.

oRecommendations include standardizing testing, reducing unnecessary tests, and streamlining referral processes for better efficiency and patient outcomes.