Early Pregnancy Loss in the Emergency Department, 2006-2016

Abstract

Objectives: Although women experiencing early pregnancy loss (EPL) often present to the emergency department (ED), the burden of EPL on the ED is not well understood. We aimed to estimate the proportion of ED visits for EPL-related care and determine the characteristics associated with seeking care for EPL in the ED in a national sample. Methods: We conducted a cross-sectional analysis of the 2006 – 2016 National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of U.S. ED visits. We identified women ages 15-44 years old who presented to the ED for EPL-related care, including those who had threatened or confirmed EPL based on a chief complaint of bleeding in pregnancy or diagnosis of missed, spontaneous, or threatened abortion, respectively. We estimated the proportion of all ED visits attributable to EPL-related care among all ED visits and among women 15-44 years old. Using multivariable logistic regression, we evaluated patient and visit characteristics associated with receiving EPL-related care. Women in this age group presenting for any other reason were used as a comparator. Results: The 2006-2016 NHAMCS dataset included 325,037 visits (weighted n=1,447,144,423), including 82,871 visits among women ages 15-44 (weighted n=371,016,125). Of all ED visits from 2006 through 2016, 1.28% (95% CI, 1.21-1.34) were for EPL-related care. This is equivalent to 1.5 million visits each year, or 4.5% (95% CI, 4.3, 4.7) of visits for women ages 15-44 years old. Compared to all women ages 15-44 years old presenting to the ED for non-EPL related visits, those presenting with EPL were younger and more likely to be Black or Hispanic and publicly insured. Conclusions: EPL-related care accounts for a substantial proportion of ED visits among reproductive aged women nationally. Given the prevalence, ED providers should be trained and equipped to evaluate and manage EPL.