Suzanne M. Cox, MPH¹, Sarah J. Kilpatrick, MD, PhD², and Stacie Geller, PhD². (1) Community Health Sciences, University of Illinois at Chicago, School of Public Health, 1601 W Taylor St., Chicago, IL 60612, 312-413-8379, scox3@uic.edu, (2) Department of Obstetrics and Gynecology (MC 808), University of Illinois, College of Medicine, 820 S. Wood Street, Chicago, IL 60612

OBJECTIVE

The purpose of the study was to determine if the point of entry to medical care for pregnant women experiencing symptoms of illness is associated with severity of maternal outcome.

METHODS

A case control design was used to compare cases (pregnancy-related mortalities) to controls (severe maternal morbidities). A clinical team at the University of Illinois, Chicago, used medical record review to determine the point of entry for 214 women (35 cases/mortalities and 179 controls/severe morbidities). Odds ratios and chi square tests were calculated.

RESULTS

Using Pearson’s chi-square, we found a significant difference (p<.001) in the distribution of points of entry among cases and controls. Of the cases, 54.3% presented to non-obstetric points of entry while only 27.6% of controls did. Odd Ratios showed an increased risk (1.92) for non-obstetric versus inpatient obstetric points of entry. Additionally, both non-obstetric and inpatient obstetric points of entry showed an increased risk of death when compared to outpatient obstetric (21.17 and 11.04 respectively).

CONCLUSION

The results show the new or previously undocumented information that women who died were more likely to have a non-obstetric point of entry than women with a severe morbidity. This illustrates that emergency departments are a likely point of entry for acutely ill pregnant women who have a high chance of life threatening morbidity and death. Given that emergency department personnel may not be as familiar with the unique conditions of pregnancy, we would recommend multidisciplinary focused education about seriously ill pregnant women to reduce maternal morbidity and mortality.

Learning Objectives: "At the conclusion of the session, the participant in this session will be able to

• List the three main types of point of entry to medical care for pregnant and postpartum women experiencing signs and symptoms of illness.
• Discuss the implications of high rates of emergency room points of entry for women who die of pregnancy-related causes.
• Identify possible intervention strategies to reduce preventable deaths and near-miss morbidities through multidisciplinary focused education about seriously ill pregnant women.

Keywords: Emergency Department/Room, Maternal Morbidity

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.