Characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor or preterm premature rupture of membranes.

BACKGROUND

Hospital-based obstetrical triage units frequently serve as an extension to outpatient care. Evaluation of the burden of preterm birth (PTB) typically focuses on the delivery and neonatal periods, while antepartum health care utilization related to risk of PTB is seldom reported.

OBJECTIVE

To identify the characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor (PTL) or preterm premature rupture of membranes (pPROM).

STUDY

DESIGN

Secondary analysis of a retrospective cohort study of all triage visits from 20 0/7 through 34 6/7 weeks gestation on randomly selected dates in 2019 at 34 hospitals across the US. Those in whom the reason for the visit was suspected PTL or pPROM and who were subsequently discharged were eligible for this analysis. Patients with ≥3 triage visits were compared with those who had <3 visits in the index pregnancy visits. Data were abstracted by certified research personnel using predefined criteria. The primary outcome was a composite of severe neonatal morbidity or mortality before 120 days. Secondary outcomes included PTB (<37 weeks gestation), a composite of respiratory neonatal morbidities, and maternal outcomes. Multivariable logistic regression analyses were used for the maternal outcomes, and generalized linear and logistic models were used for the neonatal outcomes to account for the correlation among twins.

RESULTS

A total of 1764 mother/newborn dyads were included. Patients with more frequent triage visits (≥3) were more likely to self-identify as Black, be younger, not married/living with a partner, unemployed, have government-assisted insurance, or have less than a college degree compared to those individuals with less frequent triage visits (P<.05). Additionally, individuals in the more frequent triage visits group were more likely to be multiparous, have obesity, and pre-existing medical conditions, including kidney or liver disease requiring treatment (P<.05). There were no significant differences between groups for the primary composite neonatal outcome (1.6% in the more frequent group vs 2.4% in the less frequent group, adjusted odds ratios [aOR] 0.69, 95% CI 0.35-1.39) or secondary neonatal outcomes including PTB less than 37 weeks gestation (25.2% vs 23.2%, aOR 0.94, 95% CI 0.68-1.30), composite of respiratory morbidity (11.8% vs 11.0%, aOR 1.01, 95% CI 0.71-1.43), SGA (10.5% vs 10.6%, aOR 0.92, 95% CI 0.66-1.29), or birthweight (3056±639 g vs 3048±678 g, LS mean 27, 95% CI -27, 82). Similarly, there were also no statistically significant differences between groups for the secondary maternal outcomes including composite of severe maternal morbidity (8.1% vs 8.7%, aOR 1.00, 95% CI 0.69-1.44), composite of maternal infection (5.8% vs 5.1%, aOR 1.11, 95% CI 0.72-1.73), or delivery via cesarean section (31.2% vs 35.2%, aOR 0.86, 95% CI 0.69-1.07).

CONCLUSION

In this multisite registry of triage visits with rigorous ascertainment and data collection, multiple visits (≥3) for suspected PTL or pPROM were not associated with differences in maternal or neonatal outcomes.