Emergency Care Utilization During Pregnancy: Identifying Opportunities for Intervention
topic area
Maternal, Infant, and Child Health
status
Analysis
about
Emergency department (ED) use is common during pregnancy — one quarter of patients who ultimately progress to delivery will have at least one antepartum ED visit, and an estimated 10% have multiple ED visits in the same pregnancy. Access to emergency care is essential for individuals who experience complications or new symptoms, particularly early in pregnancy before they may have established outpatient obstetric care. However, repeat ED visits during pregnancy may reflect care-seeking for ambulatory sensitive conditions that could be managed in outpatient settings but, due to lack of access or barriers to care, are managed in the ED. Recurrent ED visits may also represent a sentinel indicator of obstetric risk, as ED use in pregnancy has been associated in some populations with severe maternal morbidity (SMM), preterm birth, increased medical comorbidities, and increased postpartum ED visits and admissions.
Patients receiving emergency care during pregnancy are more likely to be younger, Black or Hispanic, or publicly insured. These disparities may reflect barriers to accessing outpatient care as well as greater psychosocial vulnerabilities. A qualitative study of uninsured and Medicaid-insured pregnant patients in West Philadelphia examined perspectives on the use emergency or obstetric triage care — also known as unscheduled care — and found that unscheduled care was perceived to be more accessible than outpatient care. The study identified that individuals with psychosocial issues and individuals with symptoms that were perceived to be inadequately addressed in ambulatory care were high utilizers of unscheduled care.
By identifiying individuals with frequent emergency care use or fragmented care during pregnancy, we have an opportunity to implement novel interventions to prevent negative pregnancy outcomes and address maternal health disparities. In this study, the AHE research team will examine ED use and care fragmentation by pregnancy outcomes (delivery, ectopic pregnancy, early pregnancy loss), at different time periods during pregnancy (before and after initiation of outpatient obstetric care), and among historically marginalized populations. The team will also work to determine the association between emergency care use during pregnancy and comorbidities that predispose to obstetric risk, and between emergency care use and SMM among pregnancies ending in delivery.
looking ahead
The AHE team plans to use findings from this analysis to identify opportunities for intervention to address maternal health disparities.
partners
