Emergency department utilization and outcomes for patients with early pregnancy complications

Abstract

<h3>Objectives</h3> Pregnant patients frequently access care in the emergency department (ED); however, there is a paucity of evidence regarding resource utilization and outcomes for patients with early pregnancy complications and early pregnancy loss. <h3>Methods</h3> This was a retrospective cohort study of pregnant (≤20 week), adult (≥18 years) women in 2 EDs (1 community hospital and 1 academic hospital) in Toronto, Ontario, Canada between January 2010 and December 2017. Patients were identified by diagnostic codes indicating early pregnancy complications. <h3>Results</h3> A total of 16,091 patients were included, with a mean age of 32.8 years. These patients had 22,410 ED visits for early pregnancy complications, accounting for 1.6% of the EDs' visits during the study period. Threatened abortion (n=11,265, 50.3%) was the most common ED diagnosis, followed by spontaneous abortion (n=5,652, 25.2%), ectopic pregnancy (n=3,242, 14.5%) and missed abortion (n=1,541, 6.9%). Radiologist-interpreted ultrasound was performed on 8,000 (44.8%) patients during the initial ED visit. Mean ED length of stay was 4.0 (SD 2.8) hours. There were 4,561 (25.6%) return ED visits within 30 days, of which 2,317 (50.8%) occurred ≤24 hours of index visit and 481 (10.5%) were for next day ultrasound. The total number of hospital admissions was 1,793 (8.0%), and the majority were for ectopic pregnancy (n=1,052, 58.7%). Of admitted patients, 1,320 (73.6%) underwent surgical interventions. There were 474 (10.4%) patients admitted to hospital during return ED visits. <h3>Conclusions</h3> This study highlights the heavy reliance on Ontario EDs as care providers for patients experiencing complications of early pregnancy.