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Emergency Department Care in the Postpartum Period: California Births, 2009–2011

Batra, Priya MD, MS; Fridman, Moshe PhD; Leng, Mei MD, MS; Gregory, Kimberly D. MD, MPH

doi: 10.1097/AOG.0000000000002269
Contents: Original Research

OBJECTIVE: To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth.

METHODS: This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days (“high utilization”) and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis.

RESULTS: Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08–2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98–2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49–1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42–1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37–1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95).

CONCLUSION: One in 12 California women visited the emergency department in the first 90 days after postpartum discharge. Women at increased risk for postpartum emergency department use per our validated model (eg, low income, birth complications) may benefit from earlier scheduled postpartum visits.

One in 12 California women seek emergency department care within 90 days of delivery; most visits occur before the traditional 6-week postpartum visit.

Center for Healthy Communities, School of Medicine, University of California, Riverside, and AMF Consulting, the Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, California.

Corresponding author: Priya Batra, MD, MS, School of Medicine—Education Building, University of California, Riverside 900 University Avenue, Riverside, CA 92521; email:

Dr. Batra's time was partially supported by the Robert Wood Johnson Foundation (Grant 71897).

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Presented as a poster at the 37th Annual Pregnancy Meeting of the Society for Maternal-Fetal Medicine, January 23–28, 2017, Las Vegas, Nevada.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.