General medicine/original research
Emergency Department Visits During the Postpartum Period: A Canadian Cohort Study

https://doi.org/10.1016/j.annemergmed.2021.09.419Get rights and content
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Study objective

Challenges in transitioning from obstetric to primary care in the postpartum period may increase emergency department (ED) visits. This study described the frequency, characteristics, and predictors of maternal ED visits in the postpartum period.

Methods

Retrospective cohort study of all live-birth pregnancies occurring in Alberta (Canada) between 2011 and 2017. Individual-level health and ED utilization data was linked across 5 population health databases. We calculated age-standardized ED visit rates in the postpartum period and used negative binomial regression models to assess the outcome of any ED visit in the postpartum period associated with relevant sociodemographic and clinical factors. Results were reported using rate ratios (RRs) and 95% confidence intervals (95% CIs).

Results

Data on 255,929 pregnancies from 193,965 individuals were analyzed. During the study period, 44.7% of pregnancies had 1 or more ED visits; 29.7% of visits occurred within 6 weeks after delivery. Increased postpartum ED visits were associated with living in remote (RR, 2.8; 95% CI, 2.6 to 2.9) or rural areas (RR, 2.3; 95% CI, 2.3 to 2.4), age less than 20 years (RR, 2.5; 95% CI, 2.4 to 2.6), mental (RR, 1.6; 95% CI, 1.6 to 1.7) and major/moderate health conditions (RR, 1.5; 95% CI, 1.5 to 1.6), multiparity 4 or more (RR, 2.0; 95% CI, 1.9 to 2.1), cesarean delivery (RR, 1.4; 95% CI, 1.4 to 1.4), and intensive prenatal care (RR, 1.4; 95% CI, 1.4 to 1.5).

Conclusion

Almost one third of ED visits in the postpartum occurred within 6 weeks immediately after delivery. Potential gaps in equitable access and quality of prenatal care should be bridged by appropriate transitions to primary care in the postpartum period.

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Please see page 544 for the Editor’s Capsule Summary of this article.

Supervising editor: Daniel A. Handel, MD, MBA. Specific detailed information about possible conflict of interest for individual editors is available at https://www.annemergmed.com/editors.

Author contributions: MBO, RJR, BHR, AM, RC, SC, and SJ were responsible for the study concept and design. SC and SJ were responsible for acquisition of the data. BM, RJR, JSL, and MBO analyzed and interpreted the data. BM and MBO drafted the manuscript. The manuscript was critically revised for important intellectual content (MBO, BM, RJR, BHR, AM, RC, SC, SJ, and JSL), statistical expertise (RJR), and acquisition of funding (MBO). MBO takes responsibility for the paper as a whole.

All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This research was funded by a Health Outcomes Improvement Fund Operating Grant and the Lois Hole Hospital for Women through a Women and Children’s Health Research Institute Recruitment Award (Edmonton, AB) to Dr. Ospina. Dr. Rowe’s research is supported by a Scientific Director’s Grant (SOP 168483) from the Canadian Institutes of Health Research (CIHR) through the Government of Canada (Ottawa, ON), which supported the statistical analysis. Dr. Ospina is supported by CIHR as a Canada Research Chair in Life Course, Social Environments and Health through the Government of Canada.

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© 2021 by the American College of Emergency Physicians.