Emergency consultations in obstetrics: identification of decisive, contributing and associated factors
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MATERNAL-FETAL MEDICINE
Emergency consultations in obstetrics: identification of decisive, contributing and associated factors Katharina Schramm1,6 · Juliane Nees1 · Janine Hoffmann5 · Thomas Bruckner2 · Markus W. Haun3 · Imad Maatouk3 · Holger Stepan4 · Sarah Schott1 Received: 22 April 2020 / Accepted: 18 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. Methods This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). Results This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p one visit: 47.3%). Each group showed significant well-being differences compared to group 1 (2: p = 0.0022; 3: p = 0.0022). In terms of anxiety, groups 2 and 3 showed significantly increased scores in comparison to group 1 (2: p = 0.0098; 3: p = 0.0017).
Characteristics of study subjects Four hundred ninety-six pregnant women aged 18–46 years were analysed in this study. Their patient characteristics are shown in Table 3, sub-grouped according to the frequency of ED visits: group 1 without any ED visits, group 2 with one prior ED visit and group 3 with more than one prior ED visit. Some of the study participants were included in another sub-analysis and have been published by Schramm et al. [6, 9].
Anamnestic and social factors impacting recurrent emergency department visits Women with several previous ED visits (group 3) were on average 2.1 years younger (mean maternal age; p 1 prior ED consultation. Prevalence in %
All
Group 1
Group 2
Group 3
0
5
10
15
20
25
30
35
40
45
50
Prevalence within a group in % anxiety
depression
reduced wellbeing
Discussion Table 4 Average health status scores as measured by the SF-12 All
Group 1 Group 2 Group 3 p value n = 135 n = 160 n = 99
Physical health status 38.3 39.7 score Mental health status 51.7 53.5 score
38.1
36.6
0.0403*
51.3
49.9
0.0135*
*Significance p 1 (n = 137, 38 invalid answers)
women with previous ED visits regarded the friendliness of the staff (Cramer’s V = 0.1160), the ambience (Cramer’s V = 0.1036), and coziness (Cramer’s V = 0.1467) of the labor and delivery rooms as more important when cho
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