The following is a summary of “A national analysis of ED presentations for early pregnancy and complications: Implications for post-Roe America,” published in the August 2023 issue of Emergency Medicine by Goodwin et al.

The initial management of most obstetric emergencies typically occurs in the emergency department (ED). The Supreme Court ruling terminated constitutional safeguarding of abortion rights, enabling states to promptly implement legislation that may significantly alter the field of reproductive medicine. In this post-Roe medical environment, the ambiguity and uncertainty imposed on healthcare providers regarding the legality of specific medical procedures may have catastrophic consequences. To comprehend and strategize for the forthcoming modifications and endeavor to alleviate unfavorable results, investigators initially evaluated the existing care condition for pregnancy-related complications in the emergency department (ED) environment. This study employed data acquired from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess patterns in pregnancy-related emergency department (ED) visits between 2016 and 2020 that may be influenced by the limited availability of abortion services and legislation triggering such visits. They subsequently examined the legislative modifications and interpreted the relevant ones to clarify misconceptions and establish a structure for suitable medical procedures. The retrospective study employed data from the NHAMCS database from 2016 to 2020, encompassing an estimated total of 4,556,778 emergency department visits related to pregnancy. 

NHAMCS, short for National Hospital Ambulatory Medical Care Survey, is a comprehensive data collection method conducted by the esteemed National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC). This method involves a systematic sampling technique to gather information from emergency departments (EDs) across the United States annually. All data were analyzed using medical statistical methods, including descriptive statistics such as proportions and 95% CIs. Moreover, the Supreme Court ruling was examined alongside various state statutes and legal documents. The results were summarized and discussed. The majority (79.4%) of all examined visits were for patients aged 18–34 years, encompassing individuals in their prime reproductive period. This age group also comprised the majority (76.4%) of visits for pathologic pregnancies, such as ectopic and molar pregnancies, and 79.8% of visits for a spontaneous miscarriage or threatened miscarriage in the early stages of pregnancy. A total of 25.7% of patients were identified as individuals of African descent, while 70.1% were identified as individuals of European descent. In terms of ethnicity, patients were categorized as Hispanic and non-Hispanic, with Hispanic patients accounting for 27% of all emergency department (ED) visits for the specified diagnoses from 2016 to 2020. Most holidays for complications following an induced abortion were observed in the southern region (70.8%) and exhibited a nearly twofold higher likelihood of occurrence in non-metropolitan areas. 

Roughly 18% of patients presenting with a pathological pregnancy necessitated hospitalization, and around 50% of those visits for pathological pregnancies and visits for pregnancy-related bleeding underwent a procedure in the emergency department (49.8% and 49.5%, respectively). There were an estimated 111,264 visits in which methotrexate was administered, accounting for approximately 1 in 7 trips related to ectopic or molar pregnancy. In this dataset, an estimated 14,000 patients experiencing miscarriage and early bleeding were administered misoprostol. Emergency department visits related to pregnancy constitute a substantial portion of medical care sought in emergency settings. 

Researchers advise healthcare professionals to remain aware of the swiftly progressing legislation in their specific jurisdiction and adhere to the Emergency Medical Treatment and Active Labor Act (EMTALA) while providing medical care. The prioritization of patient safety is of utmost importance.

Source: sciencedirect.com/science/article/abs/pii/S073567572300253X