Abstract
The COVID-19 pandemic has disrupted currently held norms and best practices for women who require evaluations and interventions for Obstetrics and gynecology (Ob/Gyn) emergency care. The resulting paradigm shifts have demonstrated a reassessment of how Ob/Gyn emergency care is provided in an acute setting while avoiding potential short and long-term harm. The objective of this study is to retrospectively evaluate if patients self-selected to avoid Emergency Department (ED) visits for perceived minor complaints and if postponing such care increased morbidity. Patients accessing Ob/Gyn ED care during the Covid-19 "lockdown period" (group A) in New York State were compared with those during a similar time frame in 2019 (group B). Primary outcomes were the number of ED visits and admission diagnoses. Secondary outcomes were the number of surgeries and clinical acuity on presentation. There was a 72% reduction in the total number of ED visits in group A compared to group B. Although the majority of the visits were for abdominal pain and vaginal bleeding in both groups, among patients who presented with vaginal bleeding in group A, a significantly higher number was due to early pregnancy loss rather than non-pregnancy-related uterine bleeding. The number of visits for non-emergency visits such as vulvovaginitis and contraceptive management was significantly lower and absent respectively. There were 61.5% fewer cases requiring emergency surgery in group A, however, the case acuity remained high with many patients being clinically unstable at presentation. There was a nonsignificant trend of an increased number of surgeries for ectopic pregnancy and pregnancy loss in group A compared to group B. Non-emergency surgeries, and visits for pain control, wound infections or ileus were absent in group A. We conclude that the decline in the ED visits and total number of emergency surgeries during the “lockdown period “were secondary to patients’ choices. This decrease was more pronounced for minor indications; however, many patients with serious conditions had delayed ED visits until they were clinically unstable. Therefore a reassessment of how patients access Ob/Gyn care via ED is indicated, with the goal being to avoid visits for minor indications while preventing potential life-threatening complications.
Highlights
Emergency Departments (EDs) are a significant resource for medical care in the United States
Visits for Obstetrics and gynecology (Ob/Gyn) Care related issues such as incomplete abortion or retained products of conception (71% vs 58%, p
There were no differences in the numbers of ED visits for labial abscess/Bartholin’s cyst in both groups
Summary
Emergency Departments (EDs) are a significant resource for medical care in the United States. For uninsured and publicly insured patients, the ED is the primary source of medical care and admission to the hospital. This is in contrast to those with private insurance, as they are more likely to be directly admitted to the hospital from a doctor's office or clinic. [3] Many ED visits are a burden on limited resources and potentially preventable. Providing access to high-quality, community-based health care could potentially prevent the need for a significant proportion of current ED visits
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