(126) Understanding obstetric care gaps for pregnant adolescents: Comparison of obstetric capabilities of a tertiary pediatric center and an adult obstetric emergency department

Background: To better understand what services pediatric emergency departments (EDs) may need to appropriately care for pregnant adolescents, we sought to characterize the services provided to patients who initially presented to a pediatric health system with a positive pregnancy test and subsequently were referred to an adult obstetric ED. Our objective with this study was to enhance our understanding of the obstetric care capabilities of a tertiary pediatric center as compared to an ED at an adult obstetrical hospital.

Methods: In this study, we obtained a list of encounters from a pediatric tertiary care center in the emergency or outpatient setting from 3/2014 to 5/2021 in which a urine pregnancy test was performed with a positive result and the patient was referred to the ED at an adult obstetrical hospital. Two researchers reviewed documentation from pediatric visits and from resultant obstetric ED visits. Descriptive statistics and exploratory logistic regressions were calculated.

Results: 139 patients had a positive pregnancy test, and 39 (28%) were referred to the ED of an adult obstetrical hospital. Of those referred, the median age was 18 years, with 28 patients (72%) primigravida. 3 of the 39 patients went to an adult ED at an outside hospital, and 3 did not go to the adult ED as referred. Of the 33 patients who received care at the in-system obstetric ED, 26 (79%) received an abdominal ultrasound, 21 (64%) received a transvaginal ultrasound (TVUS), 26 (79%) received a quantitative hCG test, 19 (58%) received a hemoglobin test, 9 (27%) received an obstetrics consult, 4 (12%) were admitted, and 2 (6%) received Rhogam administration. In a logistic regressions model, primiparity and “red flag” emergent symptoms were significantly associated with receiving a TVUS amongst those referred (OR 7.78, 95% CI 1.01 – 60.48 and OR 14.79, 95% CI 1.37 – 159.25 respectively).

Conclusions: Most pregnant patients seen in a pediatric health system referred for adult obstetric emergency care received either an abdominal or a TVUS as well as other interventions that are standard of care in all adult ED settings. The most common intervention at the adult obstetric ED not able to be performed in the pediatric setting was TVUS. These findings suggest that having TVUS resources and training for professionals in pediatric health settings could improve the ability of pediatric centers to care for obstetric patients.