A County Hospital Experience with Reproductive Travelers to the United States for Obstetric Care: Maternal and Neonatal Outcomes.

Objective

To describe the maternal and neonatal outcomes, health care utilization, and cost to reproductive travelers for obstetric care (RTOC) at a single institution. Materials and

Methods

A retrospective chart review was conducted of women identified as reproductive travelers who delivered at Stroger Hospital in Chicago, IL when a self-pay package of obstetrical services was offered. Data included maternal characteristics and obstetric and neonatal outcomes.

Results

A total of 413 reproductive travelers delivered during the study period. The majority (88%) was of Nigerian citizenship. The median gestational age at first prenatal visit was 35 weeks with a median of three prenatal visits. The patients were in good health with a high prevalence of infectious disease and a low prevalence of chronic disease. Women had complex obstetric histories, and 28.6% had cesarean delivery, with the most common indication being prior uterine surgery. Severe maternal morbidity occurred in 4.1% of the women and admission to the neonatal intensive care unit (NICU) in 16.3% of the babies. Extra charges beyond those covered by the financial package were incurred by 230 (55.7%) of the women.

Conclusion

Reproductive travelers have better obstetric outcomes and fewer NICU admissions than non-travelers who delivered at the same institution. However, the care of RTOC in this manner is fraught with challenges, including late presentation for care, lack of medical records, providers at times managing unfamiliar conditions, and unforeseen financial obligations assumed by patients.