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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

Kellie A. Mitchell
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, Birmingham, Alabama
,
Alison J. Haddock
3   Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
,
Hamad Husainy
4   Sycamore Physicians, Florence, Alabama
,
Lauren A. Walter
5   Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Indranee Rajapreyar
6   Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
,
Martha Wingate
7   School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
,
Catherine H. Smith
8   Division of Library Sciences, University of Alabama at Birmingham, Birmingham, Alabama
,
Alan Tita
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, Birmingham, Alabama
,
Rachel Sinkey
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
2   Center for Women's Reproductive Health, Birmingham, Alabama
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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

Supplementary Material



Publication History

Received: 30 November 2020

Accepted: 17 June 2021

Article published online:
29 July 2021

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