Emergency Department Visits for Postpartum Complications

Abstract

Introduction: Most estimates of the prevalence and types of postpartum complications are based on hospital readmissions. However, using hospital readmissions (which occurs in only 1%-2% of postpartum women) is problematic as it fails to include women with postpartum complications assessed in the office or emergency department (ED). We utilized data from a cohort of women evaluated in an ED setting to better characterize complications experienced by women in the postpartum period.

Materials and methods: We performed a retrospective analysis of all postpartum visits to the ED at a tertiary care women's hospital over 6 months. We described characteristics of the population and clinical details of the ED visit, specifically the presenting complaint, delivery type, final diagnosis, and admission rate.

Results: Among 5708 deliveries during the study period, 252 women had at least one visit to the ED within 42 days after delivery, and the median timing for first visit was 7.5 days postpartum. The most common presenting complaints were wound complication (17.5%), fever (17.1%), abdominal pain (15.9%), headache/dizziness (12.3%), breast problem (10.7%), and hypertension (10.3%). Fifty-seven percent of these visits were by women who delivered vaginally and 54% of women were multiparous. The most common final diagnosis was a normal postpartum examination and only 22% of women were readmitted.

Conclusion: Women presenting to the ED postpartum period had a wide variety of medical issues but 78% were not admitted. Given the timing and low acuity of many visits, better postpartum education may be a tool to reduce nonemergent postpartum ED visits.

Keywords: emergency department; obstetrics; postpartum.