Patients with early pregnancy loss less likely to receive active management in the emergency department

1. Among patients aged 15-49 with early pregnancy loss, those diagnosed in the emergency department were less likely to receive surgical or medical management compared to those diagnosed in outpatient settings. 

Evidence Rating Level: 2 (Good)

Early pregnancy loss (EPL), defined as a spontaneous abortion before 20 weeks gestation, is the most common form of pregnancy loss, affecting approximately 10% of clinically recognized pregnancies. Many patients present to the emergency department when EPL is suspected. Anecdotally, patients complain that care received in the ED for EPL is poorer for emotional support, follow-up, and access to surgical and medical management options (active management) compared to outpatient settings; however, no prior study has determined whether management for EPL differs between the ED and outpatient clinics. In this retrospective cohort study, a nationwide insurance claims database in the US, the IBM MarketScan Research Database, was used to collect data on 117,749 pregnant individuals aged 15-49 from 2015-2019, who presented to the emergency department or an outpatient clinic for the initial management of EPL. 17.7% of patients presented to the ED, while 82.3% presented to outpatient clinics. The adjusted odds ratio for receiving active vs. expectant management in the ED compared to outpatient clinics was 0.46 (95% CI 0.44-0.47). Complications within 6 weeks of EPL management differed between the two groups as well, with the ED group having a significantly greater risk of inpatient hospitalization, hemorrhage requiring transfusion, and intrauterine infection (p <0.001), though complication rates were low overall regardless of care setting. A limitation of this study is the use of the insurance claims database to collect data, as only patients with private insurance coverage were included, which accounts for just 62% of the US population. This in turn, may impact the generalizability of results to the total population. Overall, this study finds that patients with EPL cared for in the ED were less likely to receive active management compared to outpatient clinics. Further research may explore whether there are barriers present in emergency departments limiting the ability to provide patient-centered EPL care.

Click to read the study in JAMA Network Open

Image: PD

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