ResearchObstetricsPrenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care
Section snippets
Study participants
Data from this study came from 503 pregnant women enrolled in a randomized controlled trial aimed at promoting improved general health and reproductive behaviors through group prenatal care. This was a prospective study following up participants from early pregnancy through 1 year postpartum. Participants were recruited from 2 university-affiliated obstetrics clinics in New Haven, CT, and Atlanta, GA. Inclusion criteria were: (1) pregnancy at less than 24 weeks’ gestation; (2) age younger than
Results
The sample consisted of 503 participants; 67 were excluded from analyses because they had medical conditions during pregnancy that could require additional medical visits: hypertension, diabetes, preeclampsia, multiple gestation, and fetal abnormalities. In addition, 16 participants did not complete time 2 assessments. This resulted in a final sample of 420 patients for these analyses. The 420 patients did not differ from the 83 participants not included in these analyses on any of the primary
Comment
Our study demonstrates that nearly one-third of prenatal care patients receive “adequate plus” or “excessive” scheduled prenatal care visits. This confirms the observations of Kotelchuck, who applied his index to the 1980 National Natality Survey and demonstrated that 22.2% received intensive adequate plus care.7 Analysis of birth statistics from 1981-1995 revealed a major increase in prenatal care utilization, which was mostly accounted for by an increase in excessive utilization from 18.4% in
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Emergency Department Visits During Pregnancy
2023, Annals of Emergency MedicineCitation Excerpt :The ED usage appears to be higher during pregnancy in locations without universal health care coverage, such as the United States.4,9 In these locales, up to 75% of pregnant women have had at least 1 unscheduled visit to an urban clinic (with an average of 5.3 unscheduled visits during the pregnancy).4 Previous studies have reported that up to 14.4% of perinatal ED visits might be driven by medical problems considered nonurgent but are of high importance for patients (eg, desire for a pregnancy test, strange or malodorous discharge, transient nausea, or mild abdominal discomfort).33
Differences in outpatient, emergency, and inpatient use among pregnant women with a substance-related diagnosis
2022, American Journal of Obstetrics and Gynecology MFMCitation Excerpt :Research has suggested that limited and disrupted prenatal care, psychiatric comorbidities (eg, anxiety), prenatal substance use, and environmental stressors (eg, unsteady home) are associated with adverse maternal outcomes (eg, preeclampsia, gestational hypertension, and severe maternal morbidity [SMM]).2,3 Attending prenatal visits decreases the risk of both adverse obstetrical and birth outcomes (eg, prematurity, fetal demise, and postneonatal mortality and neuropsychiatric impairments).4–7 Increased emergency department (ED) use and hospitalizations suggest worsening medical needs.
Barriers and facilitators of maternal healthcare utilisation in the perinatal period among women with social disadvantage: A theory-guided systematic review
2022, MidwiferyCitation Excerpt :These include parity and substance use. Nulliparity may not adversely impact ANC initiation (Cresswell et al., 2013) or be associated with lower odds of inadequate ANC utilisation (Magriples et al., 2008). Multiparity, however, negatively impacts utilisation and decreases the odds of having prenatal care and postpartum care (Weir et al., 2011) and is associated with late ANC (Braveman et al., 2000; Cresswell et al., 2013; Daniels et al., 2006; Heaman et al., 2014; Hulsey et al., 2000; Kapaya et al., 2015) and inadequate ANC (Heaman et al., 2014).
Practices’ evaluation of missed miscarriage diagnosis in gynecologic emergency service in Tours CHU
2020, Gynecologie Obstetrique Fertilite et SenologieThe emergency department experience of patients with early pregnancy complications: A qualitative study
2019, Canadian Journal of Emergency Medicine
Cite this article as: Magriples U, Kershaw TS, Rising SS, et al. Prenatal health care beyond the obstetrics service: Utilization and predictors of unscheduled care. Am J Obstet Gynecol 2008;198:75.e1-75.e7.
This work supported in part by National Institute of Mental Health Grant R01 MH/HD61175 to (to J.R.I.).