Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

Kellie A. Mitchell; Alison J. Haddock; Hamad Husainy; Lauren A. Walter; Indranee Rajapreyar; Martha Wingate; Catherine H. Smith; Alan Tita; Rachel Sinkey

doi:10.1055/s-0041-1732455

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2023; 40(05): 489-507
DOI: 10.1055/s-0041-1732455

Review Article

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

Autoren

Kellie A. Mitchell

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

²Center for Women's Reproductive Health, Birmingham, Alabama
Alison J. Haddock

³Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
Hamad Husainy

⁴Sycamore Physicians, Florence, Alabama
Lauren A. Walter

⁵Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Indranee Rajapreyar

⁶Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Martha Wingate

⁷School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Catherine H. Smith

⁸Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
Alan Tita

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

²Center for Women's Reproductive Health, Birmingham, Alabama
Rachel Sinkey

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

²Center for Women's Reproductive Health, Birmingham, Alabama

Abstract

Objective Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source.

Study Design We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy.

Results A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED.

Conclusion As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. This study is registered with the Systematic Review Registration (identifier: CRD42020151126).

Key Points

Up to 12% of postpartum women seek care in the ED.
One-third of maternal deaths occur postpartum.
Maternal mortality reduction efforts should include ED stakeholders.

Keywords

emergency department - maternal morbidity - maternal mortality - postpartum period - social determinants of health

Volltext

Referenzen

References
1 World Health Organizations. Trends in Maternal Mortality 2000 to 2017: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: Executive Summary. Geneva, Switzerland: World Health Organization; 2019
2 Organization WH. Maternal Mortality: key facts. . Accessed July 1, 2021 at: https://www.who.int/news-room/fact-sheets/detail/maternal-mortality
3 Petersen EEDN, Davis NL, Goodman D. et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep 2019; 68 (18) 423-429
4 Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Accessed July 1, 2021 at: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm#:~:text=Each%20year%2C%20CDC%20requests%20the,any%20additional%20data%20when%20available
5 Centers for Disease Control and Prevention. Pregnancy-related deaths. Accessed July 1, 2021 at: https://www.cdc.gov/vitalsigns/maternal-deaths/index.html
6 Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep 2018; 67 (01) 1-55
7 Daw JR, Hatfield LA, Swartz K, Sommers BD. Women in the United States experience high rates of coverage ‘churn’ in months before and after childbirth. Health Aff (Millwood) 2017; 36 (04) 598-606
8 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
9 Office of Disease Prevention and Health Promotion. Social determinants of health. Accessed October 15, 2020 at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
10 Clark SL, Belfort MA, Dildy GA. et al. Emergency department use during the postpartum period: implications for current management of the puerperium. Am J Obstet Gynecol 2010; 203 (01) 38.e1-38.e6
11 Batra P, Fridman M, Leng M, Gregory KD. Emergency department care in the postpartum period: California births, 2009-2011. Obstet Gynecol 2017; 130 (05) 1073-1081
12 Vikström A, Johansson SE, Barimani M. Postnatal ER visits within 30 days-Pattern, risk factors and implications for care. J Clin Nurs 2018; 27 (3,4): 769-776
13 Mitra M, Parish SL, Akobirshoev I, Rosenthal E, Moore Simas TA. Postpartum hospital utilization among Massachusetts women with intellectual and developmental disabilities: a retrospective cohort study. Matern Child Health J 2018; 22 (10) 1492-1501
14 Kamel H, Roman MJ, Pitcher A, Devereux RB. Pregnancy and the risk of aortic dissection or rupture: a cohort-crossover analysis. Circulation 2016; 134 (07) 527-533
15 Wang W-W, Wang Y. Peripartum women with dyspnea in the emergency department: is it peripartum cardiomyopathy?. Medicine (Baltimore) 2018; 97 (31) e11516
16 Brousseau EC, Danilack V, Cai F, Matteson KA. Emergency department visits for postpartum complications. J Womens Health (Larchmt) 2018; 27 (03) 253-257
17 Brousseau EC, Danilack V, Cai F, Matteson K. Emergency department visits for postpartum hypertension. Hypertens Pregnancy 2017; 36 (02) 212-216
18 Yancey LM, Withers E, Bakes K, Abbott J. Postpartum preeclampsia: emergency department presentation and management. J Emerg Med 2011; 40 (04) 380-384
19 Bigelow CA, Pereira GA, Warmsley A. et al. Risk factors for new-onset late postpartum preeclampsia in women without a history of preeclampsia. Am J Obstet Gynecol 2014; 210 (04) 338.e1-338.e8
20 Yokoe DS, Christiansen CL, Johnson R. et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001; 7 (05) 837-841
21 Behcet A, Esref A, Ozgur O, Abdullah A, Mustafa A. Pregnancy-related strokes in southeast Turkey. Neurosciences (Riyadh) 2007; 12 (03) 207-214
22 Karadas S, Milanlioglu A, Gönüllü H, Sayin R, Aydin MN. Cerebral venous sinus thrombosis presentation in emergency department in Van, Turkey. J Pak Med Assoc 2014; 64 (04) 370-374
23 Lai JY, Huang TL. Catatonic features noted in patients with post-partum mental illness. Psychiatry Clin Neurosci 2004; 58 (02) 157-162
24 Polachek IS, Fung K, Vigod SN. First lifetime psychiatric admission in the postpartum period: a population-based comparison to women with prior psychiatric admission. Gen Hosp Psychiatry 2016; 40: 25-32
25 Shlomi-Polachek I, Fung K, Meltzer-Brody S, Vigod SN. Short stay vs long stay postpartum psychiatric admissions: a population-based study. Arch Women Ment Health 2017; 20 (04) 505-513
26 Nannini A, Lazar J, Berg C. et al. Rates of hospital visits for assault during pregnancy and the year postpartum: timing matters. Public Health Rep 2011; 126 (05) 664-668
27 Agrawal A, Ickovics J, Lewis JB, Magriples U, Kershaw TS. Postpartum intimate partner violence and health risks among young mothers in the United States: a prospective study. Matern Child Health J 2014; 18 (08) 1985-1992
28 Harrykissoon SD, Rickert VI, Wiemann CM. Prevalence and patterns of intimate partner violence among adolescent mothers during the postpartum period. Arch Pediatr Adolesc Med 2002; 156 (04) 325-330
29 Scribano PV, Stevens J, Kaizar E. NFP-IPV Research Team. The effects of intimate partner violence before, during, and after pregnancy in nurse visited first time mothers. Matern Child Health J 2013; 17 (02) 307-318
30 Kothari CL, Cerulli C, Marcus S, Rhodes KV. Perinatal status and help-seeking for intimate partner violence. J Womens Health (Larchmt) 2009; 18 (10) 1639-1646
31 Kamel H, Navi BB, Sriram N, Hovsepian DA, Devereux RB, Elkind MS. Risk of a thrombotic event after the 6-week postpartum period. N Engl J Med 2014; 370 (14) 1307-1315
32 Goodacre S, Horspool K, Nelson-Piercy C. et al; DiPEP research group. The DiPEP study: an observational study of the diagnostic accuracy of clinical assessment, D-dimer and chest x-ray for suspected pulmonary embolism in pregnancy and postpartum. BJOG 2019; 126 (03) 383-392
33 Goodacre S, Horspool K, Shephard N. et al. Selecting pregnant or postpartum women with suspected pulmonary embolism for diagnostic imaging: the DiPEP diagnostic study with decision-analysis modelling. Health Technol Assess 2018; 22 (47) 1-230
34 Kabrhel C, Mark Courtney D, Camargo Jr. CA. et al. Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism. Acad Emerg Med 2010; 17 (06) 589-597
35 Bryant A, Blake-Lamb T, Hatoum I, Kotelchuck M. Women's Use of Health Care in the First 2 Years Postpartum: Occurrence and Correlates. Matern Child Health J 2016; 20 (01, Suppl 1) 81-91
36 França ULMM, McManus ML. Frequency, trends, and antecedents of severe maternal depression after three million U.S. births. PLoS One 2018; 13 (02) e0192854
37 Sheen J-J, Smith HA, Tu B, Liu Y, Sutton D, Bernstein PS. Risk factors for postpartum emergency department visits in an urban population. Matern Child Health J 2019; 23 (04) 557-566
38 Nannini A, Lazar J, Berg C. et al. Injury: a major cause of pregnancy-associated morbidity in Massachusetts. J Midwifery Womens Health 2008; 53 (01) 3-10
39 Alam N, Chowdhury ME, Kouanda S. et al. The role of transportation to access maternal care services for women in rural Bangladesh and Burkina Faso: A mixed methods study. Int J Gynaecol Obstet 2016; 135 (Suppl. 01) S45-S50
40 Kurtz Landy C, Sword W, Ciliska D. Urban women's socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey. BMC Health Serv Res 2008; 8: 203-203
41 Madlon-Kay DJ, DeFor TA. Maternal postpartum health care utilization and the effect of Minnesota early discharge legislation. J Am Board Fam Pract 2005; 18 (04) 307-311
42 Watt S, Sword W, Krueger P. Longer postpartum hospitalization options--who stays, who leaves, what changes?. BMC Pregnancy Childbirth 2005; 5 (01) 13
43 Mandl KD, Brennan TA, Wise PH, Tronick EZ, Homer CJ. Maternal and infant health: effects of moderate reductions in postpartum length of stay. Obstet Gynecol Surv 1998; 53 (05) 273-274
44 Lieu TA, Wikler C, Capra AM, Martin KE, Escobar GJ, Braveman PA. Clinical outcomes and maternal perceptions of an updated model of perinatal care. Pediatrics 1998; 102 (06) 1437-1444
45 Laliberté C, Dunn S, Pound C. et al. A randomized controlled trial of innovative postpartum care model for mother-baby dyads. PLoS One 2016; 11 (02) e0148520
46 Johnson TRB, Zettelmaier MA, Warner PA, Hayashi RH, Avni M, Luke B. A competency based approach to comprehensive pregnancy care. Womens Health Issues 2000; 10 (05) 240-247
47 Murray L, Woolgar M, Murray J, Cooper P. Self-exclusion from health care in women at high risk for postpartum depression. J Public Health Med 2003; 25 (02) 131-137
48 Hsieh T-H, Chao T-H, Chang C-J, Chen J-H. Acute aortic dissection associated with left ventricular dysfunction in a postpartum and normotensive young woman. J Formos Med Assoc 2003; 102 (05) 331-333
49 Acar B, Unal S, Yayla Ç, Karakurt M, Akın Y. Multiple intracardiac thrombus in a young patient with peripartum cardiomyopathy. Int J Cardiovasc Acad 2017; 3 (03) 68-70
50 Akpinar G, Ipekci A, Gulen B, Ikizceli I. Beware postpartum shortness of breath. Pak J Med Sci 2015; 31 (05) 1280-1282
51 Amit BH, Marmor A, Hussein A. Unilateral presentation of postpartum cardiomyopathy misdiagnosed as pneumonia. BMJ Case Rep 2010; 2010: bcr0520103039
52 Bryan JJ. Lessons of the heart. J Miss State Med Assoc 2005; 46 (09) 276-280
53 Czerwinski EM. Case report: postpartum cough and dyspnea. Adv Emerg Nurs J 2016; 38 (03) 190-198
54 Lam TSKLC, Kam CW. Three cases of peripartum cardiomyopathy. Hong Kong J Emerg Med 2008; 15 (04) 230-234
55 Sönmez BM, İşcanlı MD, Durdu T, Kala İ, Tarhan N, Uysal P. What's going wrong with this postpartum woman?. Am J Emerg Med 2018; 36 (04) 737.e1-737.e4
56 Yamanoglu A, Celebi Yamanoglu NG, Cakmak S, Sogut O. A young puerperal woman presenting to emergency department with severe dyspnea. Turk J Emerg Med 2017; 17 (04) 154-156
57 Abisaab J, Nevadunsky N, Flomenbaum N. Emergency department presentation of bilateral carotid artery dissections in a postpartum patient. Ann Emerg Med 2004; 44 (05) 484-489
58 Alterie J, Villanueva F, Arekat M, Brill A. . An unusual presentation of postpartum spontaneous coronary artery dissection. Clin Pract Cases Emerg Med 2019; 3 (03) 229-232
59 Dahiya S, Ooi WB, Hernández-Montfort JA. Spontaneous coronary artery dissection--a mimic. Acute Card Care 2012; 14 (03) 103-104
60 Frey BW, Grant RJ. Pregnancy-associated coronary artery dissection: a case report. J Emerg Med 2006; 30 (03) 307-310
61 Manchala VTS, Pun M. Postpartum recurrent spontaneous coronary artery dissection: A case report and review of literature. Conn Med 2018; 82 (09) 551-554
62 Mansur LIMG, Minns GO, Steckley RA. Postpartum myocardial infarction: association with primary coronary artery dissection. Cleve Clin J Med 1995; 62 (04) 261-268
63 Moussa HN, Movahedian M, Leon MG, Sibai BM. Acute myocardial infarction due to coronary artery dissection in the postpartum period. AJP Rep 2015; 5 (02) e093-e096
64 Pillow MT, Nguyen NA, Kuo D. Cardiac arrest from postpartum spontaneous coronary artery dissection. West J Emerg Med 2011; 12 (04) 567-570
65 Squire G, Eltayeb M, Hogrefe K. ‘Hearing hooves, finding zebras’: the differential diagnosis of cardiac arrest precipitated by chest pain in the postpartum woman. BMJ Case Rep 2018; 11 (01) e227048
66 Stamboulis E, Raptis G, Andrikopoulou A. et al. Spontaneous internal carotid artery dissection: an uncommon cause of recurrent postpartum headache. J Neuroimaging 2011; 21 (01) 76-78
67 Terrovitis JV, Kanakakis J, Nanas JN. Spontaneous coronary artery dissection as a cause of acute myocardial infarction in the postpartum period. Cardiol Rev 2005; 13 (04) 211-213
68 Vilke GM, Mahoney G, Chan TC. Postpartum coronary artery dissection. Ann Emerg Med 1998; 32 (02) 260-262
69 Koneru J, Cholankeril M, Patel K. et al. Postpartum coronary vasospasm with literature review. Case Rep Cardiol 2014; 2014: 523023-523023
70 Nall KS, Feldman B. Postpartum myocardial infarction induced by methergine. Am J Emerg Med 1998; 16 (05) 502-504
71 Uehara K, Fujinaga H, Nakayama T. et al. Acute myocardial infarction in a 35-year-old postpartum woman. J Med 2003; 34 (1–6): 67-79
72 Loewe C, Dragovic LJ. Acute coronary artery thrombosis in a postpartum woman receiving bromocriptine. Am J Forensic Med Pathol 1998; 19 (03) 258-260
73 Ghashimi I, Jafarah L, Bakhsh A. et al. Simultaneous multiple thromboembolic events in a postpartum patient. Clin Pract Cases Emerg Med 2018; 2 (03) 231-234
74 The Ottawa Hospital Research Institute. Wells GA, Shea B, O'Connell D. et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed July 1, 2021 at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp
75 Brown HK, Cobigo V, Lunsky Y, Vigod S. Postpartum acute care utilization among women with intellectual and developmental disabilities. J Womens Health (Larchmt) 2017; 26 (04) 329-337
76 Mitra M, Akobirshoev I, Parish SL, Valentine A, Clements KM, Moore Simas TA. Postpartum emergency department use among women with intellectual and developmental disabilities: a retrospective cohort study. J Epidemiol Community Health 2019; 73 (06) 557-563
77 Fabiyi CA, Reid LD, Mistry KB. Postpartum health care use after gestational diabetes and hypertensive disorders of pregnancy. J Womens Health (Larchmt) 2019; 28 (08) 1116-1123
78 Harris A, Chang H-Y, Wang L. et al. Emergency room utilization after medically complicated pregnancies: a medicaid claims analysis. J Womens Health (Larchmt) 2015; 24 (09) 745-754
79 Lewkowitz AK, Rosenbloom JI, Keller M. et al. Association between severe maternal morbidity and psychiatric illness within 1 year of hospital discharge after delivery. Obstet Gynecol 2019; 134 (04) 695-707
80 Luo FY, Crawford S, Drouin O, Chadha R. Can we predict and prevent emergency department visits for postpartum hypertensive complications in patients with hypertensive disorders in pregnancy?. J Matern Fetal Neonatal Med 2018; 33 (13) 2241-2245
81 Spicer A, Pinelli J, Saigal S, Wu YW, Cunningham C, DiCenso A. Health status and health service utilization of infants and mothers during the first year after neonatal intensive care. Adv Neonatal Care 2008; 8 (01) 33-41
82 Sparrow-Downes VM, Loutfy M, Antoniou T, Vigod SN. Postpartum mental health service utilization in women with human immunodeficiency virus (HIV): a population-based study. AIDS Care 2019; 31 (11) 1332-1339
83 Vigod SN, Bagadia AJ, Hussain-Shamsy N, Fung K, Sultana A, Dennis CE. Postpartum mental health of immigrant mothers by region of origin, time since immigration, and refugee status: a population-based study. Arch Women Ment Health 2017; 20 (03) 439-447
84 Petersen EE, Davis NL, Goodman D. et al. Racial/ethnic disparities in pregnancy-related deaths - United States, 2007-2016. MMWR Morb Mortal Wkly Rep 2019; 68 (35) 762-765
85 Howell EA. Reducing disparities in severe maternal morbidity and mortality. Clin Obstet Gynecol 2018; 61 (02) 387-399
86 MacDorman MF, Declercq E. Trends and state variations in out-of-hospital births in the United States, 2004-2017. Birth 2019; 46 (02) 279-288

Zusatzmaterial

Supplementary Material (PDF) (opens in new window)