Presentation trends, characteristics and outcomes for women with early pregnancy bleeding in the emergency department: A 10‐year data linkage study

Trostian, Baylie; McCloughen, Andrea; Fethney, Judith; Curtis, Kate

doi:10.1111/ajo.13733

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…14,15 Finally, Trostian et al discuss the trends in emergency department presentations and management for early pregnancy bleeding. 16 This issue also recognises those who have made contributions to ANZJOG as peer reviewers in the past year. ANZJOG has seen a large increase in the number of submissions over recent years and while this is very much welcome, it does bring with it an increase in the burden upon peer reviewers.…”

Section: Final Thoughts From Anzjog In 2023mentioning

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Final thoughts from ANZJOG in 2023

White

2023

Aust NZ J Obst Gynaeco

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confidence: 99%

“…Endometriosis remains a topic of interest, with this issue including articles regarding the appendix in endometriosis and an analysis of geographic variation in endometriosis surgery in Canada 14,15 . Finally, Trostian et al discuss the trends in emergency department presentations and management for early pregnancy bleeding 16 …”

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Final thoughts from ANZJOG in 2023

White

2023

Aust NZ J Obst Gynaeco

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What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?

Trostian,

McCloughen,

Curtis

2024

Emerg Medicine Australasia

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ObjectiveTo determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.MethodsRetrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non‐admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.ResultsThere was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six – psychosocial support referral or care had the biggest growth (almost 500%).ConclusionsVariation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence‐practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.

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Midwives’ and registered nurses’ role and scope of practice in acute early pregnancy care services: a scoping review

Freeman,

Warland,

Cheney

et al. 2024

JBI Evidence Synthesis

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Objective: The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks’ gestation in acute clinical settings in Australia. Introduction: In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. Inclusion criteria: Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. Methods: A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. Results: The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives’ and registered nurses’ roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women’s access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives’ practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. Conclusions: This review highlights the inconsistency in midwives’ and registered nurses’ roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. Review Registration: Open Science Framework osf.io/7zchu.

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Presentation trends, characteristics and outcomes for women with early pregnancy bleeding in the emergency department: A 10‐year data linkage study

Cited by 3 publications

References 23 publications

Final thoughts from ANZJOG in 2023

Final thoughts from ANZJOG in 2023

What proportion of women presenting to the emergency department with early pregnancy bleeding receive appropriate care?

Midwives’ and registered nurses’ role and scope of practice in acute early pregnancy care services: a scoping review

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