Emergency Department Use in the Postpartum Period: a Retrospective Cohort Study

Overview

Journal Res Sq

Date 2024 Apr 1

PMID 38558986

Authors

Elijah Reische

Mark Santillan

Victoria Cunningham

Kelsey Blocklinger

Stephen Hunter

Elissa Faro

Heather Davis

Boyd Knosp

Donna Santillan

Affiliations

Soon will be listed here.

Abstract

Background: Visits to the emergency room (ED) by women in the postpartum period may reflect gaps in postpartum care and disparities in access to obstetric and primary care services. This study aimed to characterize the patients who visited the ED in the first year after delivery, their reasons for coming to the ED, and the care they received.

Methods: The electronic health record was reviewed for all patients who delivered at University of Iowa Health Care between 2009 and 2023 and visited the ED within 365 days after delivery. Data drawn directly from the EHR included patient demographics and medical history, pregnancy and delivery information, and newborn characteristics. The charts were then reviewed manually for information regarding ED visits including time from delivery, chief complaint, diagnosis, and disposition.

Results: 555 pregnancies had ED visits within one year of delivery, with a total 814 ED visits across the study sample. 46.7% of ED visits occurred in the first 30 days following delivery, and 35% of ED visits for obstetric complaints occurred in the first 2 weeks after delivery. Black patients visited the ED more often (mean=1.84 visits, SD=1.30) than white (mean=1.34, SD=0.92, p<0.001) or Hispanic patients (mean=1.35, SD=0.67, p = 0.004). The most common categories of chief complaint were obstetric (34.6%) and gastrointestinal (18.8%), while the most common categories of diagnosis were obstetric (31.8%) and immune/infectious (28.1%).

Conclusions: Visits to the ED are common in the year following delivery. Almost half of these visits occur in the first 30 days after birth. The plurality of postpartum ED visits are due to obstetric complaints, especially in the first few weeks. Black women are more likely to use the ED during this period, potentially due to disparities in healthcare access. These findings suggest that some of these ED visits may be preventable, and that there is room for improvement in post-delivery follow-up, communication between patients and the obstetrics team, and access to outpatient obstetric care.

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Batra P, Fridman M, Leng M, Gregory K . Emergency Department Care in the Postpartum Period: California Births, 2009-2011. Obstet Gynecol. 2017; 130(5):1073-1081. DOI: 10.1097/AOG.0000000000002269. View

Fiscella K, Sanders M . Racial and Ethnic Disparities in the Quality of Health Care. Annu Rev Public Health. 2016; 37:375-94. DOI: 10.1146/annurev-publhealth-032315-021439. View

Glazer K, Harrell T, Balbierz A, Howell E . Postpartum Hospital Readmissions and Emergency Department Visits Among High-Risk, Medicaid-Insured Women in New York City. J Womens Health (Larchmt). 2022; 31(9):1305-1313. PMC: 9639235. DOI: 10.1089/jwh.2021.0338. View

Weissmann-Brenner A, Heusler I, Manteka R, Dulitzky M, Baum M . Postpartum visits in the gynecological emergency room: How can we improve?. BMC Pregnancy Childbirth. 2020; 20(1):278. PMC: 7204226. DOI: 10.1186/s12884-020-02927-7. View

Mackeen A, Packard R, Ota E, Speer L . Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015; (2):CD001067. PMC: 7050613. DOI: 10.1002/14651858.CD001067.pub3. View

Pickens G, Smith M, McDermott K, Mummert A, Karaca Z . Trends in treatment costs of U.S. emergency department visits. Am J Emerg Med. 2022; 58:89-94. DOI: 10.1016/j.ajem.2022.05.035. View

Colgan R, Williams M . Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011; 84(7):771-6. View

Brousseau E, Danilack V, Cai F, Matteson K . Emergency Department Visits for Postpartum Complications. J Womens Health (Larchmt). 2017; 27(3):253-257. PMC: 5865248. DOI: 10.1089/jwh.2016.6309. View

10.

Howell E . Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018; 61(2):387-399. PMC: 5915910. DOI: 10.1097/GRF.0000000000000349. View

11.

Schwartz M, Wang C, Eckert L, Critchlow C . Risk factors for urinary tract infection in the postpartum period. Am J Obstet Gynecol. 1999; 181(3):547-53. DOI: 10.1016/s0002-9378(99)70491-6. View

12.

Pluym I, Holliman K, Afshar Y, Lee C, Richards M, Han C . Emergency department use among postpartum women with mental health disorders. Am J Obstet Gynecol MFM. 2020; 3(1):100269. PMC: 7574686. DOI: 10.1016/j.ajogmf.2020.100269. View

13.

Clark S, Belfort M, Dildy G, Englebright J, Meints L, Meyers J . Emergency department use during the postpartum period: implications for current management of the puerperium. Am J Obstet Gynecol. 2010; 203(1):38.e1-6. DOI: 10.1016/j.ajog.2010.02.033. View

14.

Parast L, Mathews M, Martino S, Lehrman W, Stark D, Elliott M . Racial/Ethnic Differences in Emergency Department Utilization and Experience. J Gen Intern Med. 2021; 37(1):49-56. PMC: 8021298. DOI: 10.1007/s11606-021-06738-0. View

15.

Brown E, Polsky D, Barbu C, Seymour J, Grande D . Racial Disparities In Geographic Access To Primary Care In Philadelphia. Health Aff (Millwood). 2016; 35(8):1374-81. DOI: 10.1377/hlthaff.2015.1612. View

16.

Jahanfar S, Jenn Ng C, Teng C . Antibiotics for mastitis in breastfeeding women. Cochrane Database Syst Rev. 2013; (2):CD005458. PMC: 11297410. DOI: 10.1002/14651858.CD005458.pub3. View

17.

Matenchuk B, Rosychuk R, Rowe B, Metcalfe A, Chari R, Crawford S . Emergency Department Visits During the Postpartum Period: A Canadian Cohort Study. Ann Emerg Med. 2021; 79(6):543-553. DOI: 10.1016/j.annemergmed.2021.09.419. View

18.

Osterman M, Hamilton B, Martin J, Driscoll A, Valenzuela C . Births: Final Data for 2022. Natl Vital Stat Rep. 2024; 73(2):1-56. View

19.

Sheen J, Smith H, Tu B, Liu Y, Sutton D, Bernstein P . Risk Factors for Postpartum Emergency Department Visits in an Urban Population. Matern Child Health J. 2019; 23(4):557-566. DOI: 10.1007/s10995-018-2673-0. View

20.

Wilson E, Woodd S, Benova L . Incidence of and Risk Factors for Lactational Mastitis: A Systematic Review. J Hum Lact. 2020; 36(4):673-686. PMC: 7672676. DOI: 10.1177/0890334420907898. View