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Monti D, Wang CY, Yee LM, Feinglass J. Antepartum hospital use and delivery outcomes in California. Am J Obstet Gynecol MFM 2021; 3:100461. [PMID: 34411757 DOI: 10.1016/j.ajogmf.2021.100461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are few population-based studies of antepartum emergency department visits and inpatient hospitalizations and their implications for delivery outcomes. OBJECTIVE The study aimed to analyze the likelihood of pregnant patients's antepartum hospital use using population-based hospital discharge data for births in California. The study analyzed associations between antepartum hospital use and the likelihood of maternal delivery complications and postpartum hospital use. STUDY DESIGN This was a population-based retrospective cohort study of individuals with live births in state-licensed hospitals in California in 2017. Delivery admissions data were linked to antepartum hospital visits within 280 days of a delivery admission and 90 days after a delivery discharge. The most common principal or primary International Classification of Diseases, Tenth Revision-coded diagnoses for antepartum emergency department visits and inpatient hospitalizations were identified and Poisson regression estimates were used to determine the likelihood of antepartum hospital use by maternal demographic and clinical characteristics. Complicated deliveries were defined by International Classification of Diseases, Tenth Revision-coded severe maternal morbidity, vaginal or cesarean delivery complications, or long length of stay after delivery (>4 days for a vaginal delivery and >5 days for a cesarean delivery). Associations between specific types of antepartum visits, complicated deliveries, and postpartum hospital use were analyzed by chi-square tests. Logistic regression estimates were used to determine the significance of associations between antepartum hospital use and likelihood of a complicated delivery. RESULTS Of 348,848 deliveries at 246 hospitals in California, in 2017, with linkable data, almost one-third of the patients (30.4% with emergency department visits and 1.2% with inpatient hospital stays) experienced antepartum hospital use. Those who were younger, identified as a racial or ethnic minority, and with a low income, were the most likely to have antepartum hospital use. The most common primary diagnoses for antepartum emergency department visits were threatened abortions (19.6%), urinary tract infections (11.2%), and hemorrhage (9.3%). The most common principal diagnoses for antepartum hospitalizations were preterm labor (14.3%), pyelonephritis (10.2%), and hyperemesis gravidarum (6.3%). Patients with any antepartum hospital use were significantly more likely to experience a delivery complication, even after controlling for conditions coded during the delivery admission. Although having an antepartum emergency department visit was associated with only modestly increased adjusted odds (odds ratio, 1.04; 95% confidence interval, 1.01-1.08) of a complicated delivery, patients with any antepartum hospitalizations, especially those with preterm prelabor rupture of membranes, hypertension, diabetes, or hemorrhage, were at higher risk (odds ratio, 1.38; 95% confidence interval, 1.28-1.47). CONCLUSION Antepartum hospital use is frequent and is associated with patient clinical and demographic factors. Addressing the high prevalence of antepartum hospital use should be a part of future quality improvement and health equity efforts focused on improving care for patients with the greatest medical and social needs.
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Affiliation(s)
- Denise Monti
- Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Monti and Wang); Preventive Medicine Residency, Cook County Health, Chicago, IL (Dr Wang); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Yee); Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Feinglass)
| | - Chen Y Wang
- Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Monti and Wang); Preventive Medicine Residency, Cook County Health, Chicago, IL (Dr Wang); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Yee); Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Feinglass)
| | - Lynn M Yee
- Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Monti and Wang); Preventive Medicine Residency, Cook County Health, Chicago, IL (Dr Wang); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Yee); Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Feinglass)
| | - Joe Feinglass
- Program in Public Health, Northwestern University Feinberg School of Medicine, Chicago, IL (Drs Monti and Wang); Preventive Medicine Residency, Cook County Health, Chicago, IL (Dr Wang); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Yee); Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr Feinglass).
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Daykan Y, Tamir Yaniv R, Yagur Y, Pomeranz M, Arbib N, Klein Z, Schonman R. Did COVID-19 quarantine redirect habitual patient visits in the gynecology emergency room? J Gynecol Obstet Hum Reprod 2021; 50:102199. [PMID: 34329799 PMCID: PMC8314788 DOI: 10.1016/j.jogoh.2021.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
Objective COVID-19 pandemic caused a dramatic decline in the gynecology emergency department (ED) visits. The Israeli government took a determined step of quarantine to suppress and control the spread. This study evaluates the effect of the COVID -19 quarantine on gynecology emergency department (ED) visits compared to the previous year. Materials and methods A retrospective case-control study was conducted during the first half-year of the COVID-19 pandemic and focused on the quarantine during April. In order to identify differences in the population's epidemiology and changes in the amount and type of emergency gynecological visits and surgeries, we compared patients during April 2020 (COVID-19 quarantine) to those who visited the gynecology ED during April 2019. Results During January–June 2020 period, there was an overall 3707 patient visits in the gynecology ED, which represents a 22.8% decrease in patient visits compared to the previous year (2019, 4803 patients). There was a 36% decrease in the gynecology ED visits during the quarantine period. Patient demographics were similar between groups. Visits of nulliparous women were more common in the study group (p = .0001) and self-referral (p = .017). More post-operative complications and fewer patients with abdominal pain were admitted to the study group (p = .034 and p = .054, respectively). During the study, the hospitalization rate did not change 18.2% vs. 17.5% (p = 0.768). Hospitalization duration was significantly longer in the COVID-19 quarantine (2.8 ± 1.3 vs. 3.1 ± 1.5, p < 0.001). There was no significant difference among surgical procedure incidents. Conclusion Visits in the gynecology ED service decreased during the COVID-19 quarantine without compromising the treatment of gynecology emergencies. Many gynecologic complaints can be managed in community care settings without referral to an ED.
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Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel.
| | - Rina Tamir Yaniv
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Meir Pomeranz
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
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Schramm K, Nees J, Hoffmann J, Bruckner T, Haun MW, Maatouk I, Stepan H, Schott S. Emergency consultations in obstetrics: identification of decisive, contributing and associated factors. Arch Gynecol Obstet 2020; 302:821-828. [PMID: 32607806 DOI: 10.1007/s00404-020-05662-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. METHODS This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). RESULTS This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015). CONCLUSIONS Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.
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Affiliation(s)
- Katharina Schramm
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.,Children's Hospital Heilbronn, SLK-Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany.
| | - Janine Hoffmann
- Department of Obstetrics, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany
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