Evaluation, Stabilization, and Transfer of Pregnant and Postpartum Patients Presenting to Emergency Departments Without Inpatient Obstetric Services.

Abstract

More than 50% of rural critical access hospitals in the United States no longer provide inpatient obstetric services. As more hospitals close their hospital-based obstetric services, emergency physicians must still be ready to care for pregnant patients who present emergently for care. Ideally, this will include immediate medical screening examination, stabilization and transfer to a hospital with obstetric services. In other circumstances, it will result in the need to provide basic obstetric emergency care for conditions such as unanticipated delivery, postpartum hemorrhage, eclamptic seizure, and neonatal resuscitation. Emergency physicians working in hospitals without inpatient obstetric services need to have knowledge of both the closest obstetric unit they can transfer a full-term patient for obstetric triage and delivery, and where they can transfer a preterm patient at any gestational age. Level I Obstetrical Units (low-risk units) can typically accept patients with more than 37 weeks gestation. Regional maternal centers (Level III/Level IV) can typically accept any gestational age. It is critical for emergency physicians working in facilities without inpatient obstetrics to be familiar with both resources in their catchment area (eg, nearby low-risk and regional high-risk centers). This article examines the emergency physician's role in evaluation, stabilization, and transfer of pregnant and postpartum patients seeking emergency medical care at facilities without inpatient obstetric services.