Emergency department use by pregnant women: A population-based study within a universal healthcare system

Abstract

<h3>Objectives</h3> Emergency Department (ED) utilization "peri-pregnancy" may be common, but data specific to universal healthcare systems like Canada are lacking. This study was undertaken to quantify and characterize ED utilization during pregnancy. <h3>Methods</h3> This retrospective population-based cohort study included all recognized pregnancies in Ontario, conceived between April 1, 2002 and March 31, 2017. Peri-pregnancy ED utilization was defined as any ED visit from 0–42 weeks gestation, or within 42 days after the end of pregnancy. <h3>Results</h3> Peri-pregnancy ED utilization occurred among 1,075,991 of 2,728,236 recognized pregnancies (39.4%), including among 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages, and 84.8% of threatened abortions. ED utilization peaked in the first trimester and in the first week postpartum. Women residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39–3.49) for ≥ 3 ED visits, compared to those in urban areas. Women with 3–5 (OR 1.99 95% CI 1.97–2.01), 5–6 (OR 3.55, 95% CI 3.49–3.61) or ≥ 7 (OR 7.59, 95% CI 7.39–7.78) pre-pregnancy comorbidities were more likely to have ≥3 peri-pregnancy ED visits than those with 0–2 comorbidities. Of all recognized pregnancies in the cohort, only 106,989 (3.9%) had an injury-related ED visit. <h3>Conclusions</h3> Peri-pregnancy ED utilization occurs in nearly 40% of pregnancies, notably in the first trimester and immediately postpartum. Efforts are needed to streamline rapid access to ambulatory obstetrical care during these peak periods, when women are vulnerable to either a miscarriage, or a complication after a livebirth.