Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study

Abstract

omen use more health care services during pregnancy than at other times. An unforeseen or new-onset health condition -whether in pregnancy or soon after birth -may necessitate an unplanned health care visit(s), including to an emergency department. 1 A limited number of studies have suggested that emergency department use in pregnancy is often associated with suboptimal antenatal care, psychosocial instability, and worse maternal and infant outcomes. 2,3 Those studies also documented a higher rate of emergency department use among pregnant women with preexisting comorbidities than among pregnant women without preexisting comorbidities. [2][3][4] In the United States, emergency department use during pregnancy has been reported to vary between 21% and 58%, with a higher frequency of repeat emergency department visits than seen among nonpregnant women. 2-5 A major limitation of those studies is that the study populations consisted of commercially insured or low-income patients in the US, who likely differ considerably from women who receive care within health care systems such as that in Canada, where there is universal access to physician and hospital care.

Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study

“…In Ontario, most pregnant patients seen at the emergency department were under 25 years old, nulliparous, and in the first trimester of pregnancy [16]. In a study by Miller et al (2019), women reporting at the emergency department with a miscarriage were mostly under 30, pregnant for a second or subsequent time, had given birth at least once before, and had a history of miscarriage [8].…”

“…In turn, Strehlow et al (2016) and Bills et al (2018) reported that most EMS interventions for pregnant patients were performed in rural areas [ 21 , 22 ]. Similarly, Varner et al (2020) reported that most pregnant patients seen at the emergency department were rural residents [ 16 ]. Furthermore, Strehlow et al (2016) found that the emergency medical procedures performed by EMS team members most commonly included the measurement of primary vital signs—heart rate, blood pressure, and respiration rate [ 21 ], which is similar to our findings, with blood pressure measurement being performed in most cases.…”

Emergency medical care utilization, romantic attachment, and psychological distress in pregnant adolescent and young adult couples.

“…Future research should include more detailed assessments of the nature of the emergency medical care visit and explore long-term consequences of developing (or not developing) associated distress, such as relationship withdrawal or child outcomes. Understanding relationship, mental health, and physical health outcomes of emergency medical care utilization in a population that is more likely to access emergency services (Varner et al, 2020; Vladutiu et al, 2019), as well as targets to strengthen couples’ resilience, is an important future line of inquiry. Relationship focused interventions are a promising approach for racially and ethnically diverse pregnant couples interacting with the health care system.…”

“…In diverse urban couples, the problem of psychological distress following emergency medical care may be even more pressing still. African American mothers face elements of structural racism and oppression that contribute to increased risk for antenatal depression (Melville et al, 2010) and have a greater likelihood of emergency health care utilization during pregnancy (Varner et al, 2020; Vladutiu et al, 2019). In combination with increased use of emergency medical care, structural racism remains entrenched in many medical institutions (Feagin & Bennefield, 2014; Givens, 2021) and operates as an additional stressor that can compound health disparities in maternal and child health outcomes (Chae et al, 2018; Villarosa, 2018).…”

Causes of early postpartum complications that result in visits to the emergency department

“…The postpartum period is defined as six weeks following delivery, while most visits to the ED occur within 7–10 days [ 3 , 4 ]. Prior studies have looked at postpartum ED visits but none of them focused on the very early period [ 4 , 5 ].…”