The American journal of emergency medicine · 2026
The emergency department visit as an opportunity for sexually transmitted infection screening and linkage to care in early pregnancy.
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Pierce Ngozi V, Almirol Ellen, Stanford Kimberly A
Аннотация
BACKGROUND: Inadequate prenatal care (PNC) is linked to adverse pregnancy outcomes, including those related to untreated sexually transmitted infections (STIs) such as syphilis. Many populations with low PNC utilization disproportionately access the emergency department (ED). ED visits in early pregnancy may represent a critical opportunity for screening and linkage to PNC. This study aims to evaluate STI screening, diagnosis rates, and access to PNC among pregnant ED patients.
METHODS: This is a retrospective review of pregnant individuals who visited a large, urban ED and later delivered the infant at the same hospital or had ectopic pregnancies. Descriptive statistics were used to report testing and PNC data, which were extracted from the electronic medical record.
RESULTS: Of 1770 ED visits with positive pregnancy tests, 401 (22.7%) resulted in live births in the same hospital and 69 (3.9%) in ectopic pregnancies. In the live birth group, average gestational age at ED presentation was 9 (SD 4.5) weeks, and 49.1% reported plans to access PNC. Only 13.2% of ED encounters included testing for HIV, 4.7% for syphilis, and 22.9% for gonorrhea/chlamydia. More than half (54.5%) of 32 individuals with gonorrhea or chlamydia and 80% of the five with syphilis were not tested during their ED visit.
CONCLUSIONS: This study demonstrates large gaps in STI testing and access to PNC among pregnant persons visiting the ED. These findings highlight an important opportunity for early diagnosis, prevention of complications like congenital syphilis, and linkage to PNC for underserved communities utilizing the ED early in pregnancy.
METHODS: This is a retrospective review of pregnant individuals who visited a large, urban ED and later delivered the infant at the same hospital or had ectopic pregnancies. Descriptive statistics were used to report testing and PNC data, which were extracted from the electronic medical record.
RESULTS: Of 1770 ED visits with positive pregnancy tests, 401 (22.7%) resulted in live births in the same hospital and 69 (3.9%) in ectopic pregnancies. In the live birth group, average gestational age at ED presentation was 9 (SD 4.5) weeks, and 49.1% reported plans to access PNC. Only 13.2% of ED encounters included testing for HIV, 4.7% for syphilis, and 22.9% for gonorrhea/chlamydia. More than half (54.5%) of 32 individuals with gonorrhea or chlamydia and 80% of the five with syphilis were not tested during their ED visit.
CONCLUSIONS: This study demonstrates large gaps in STI testing and access to PNC among pregnant persons visiting the ED. These findings highlight an important opportunity for early diagnosis, prevention of complications like congenital syphilis, and linkage to PNC for underserved communities utilizing the ED early in pregnancy.