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Health Equity/Community Health

Poster Session 3

(690) Transport trends for early pregnancy evaluation before and after adoption of restrictive reproductive legislation

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: To evaluate the impact of the passage of restrictive abortion legislation in Texas and the federal Dobbs v Jackson Women’s health decision on transports to our Level IV maternal center for early pregnancy evaluation.

Study Design: We conducted a single-institution retrospective study on all transports to our center from 2/2021-2/2023, before and after the adoption of Texas restrictive abortion legislation (SB8–09/2021; SB4–12/2021) and the federal Dobbs decision (06/2022). Transports for early pregnancy evaluation including ectopic pregnancy, pregnancy of unknown location (PUL), miscarriage, and previable preterm prelabor rupture of membranes (PPROM). Demographics and transferring facility level of maternal care (LoMC) were compared between patients transported for early pregnancy evaluation versus transports for other indications. Severe morbidity and mortality (SMM; CDC definition) of transports were evaluated.

Results: Of the 526 patients transferred, 63 (12%) were for early pregnancy evaluation. Of those, 21 (32%) were for ectopic pregnancy, 13 (20%) for PUL, 22 (33%) for miscarriage, and 9 (13%) for previable PPROM.  Early pregnancy transports were significantly older, self-identify as Black, have lower body mass index, and be nulliparous when compared to other transports.  Early pregnancy transports were also more likely to be via ground/ambulance (96 v 68%, p< 0.0001) and from a hospital/emergency room without a labor and delivery (59 v 24%, p< 0.0001). There were no differences in SMM rates (p >0.05). There was an increase in number of patients transferred from 2021-2022 (n=29) compared to 2022-2023 (n=36), though not significantly different (p=0.4). There were increases in transport rates after 09/21 and 06/22, particularly for miscarriage management (Figure).

Conclusion: Transports to a higher LoMC center for early pregnancy evaluation increased after passage of restrictive abortion legislation suggesting potentially unwarranted transports from centers with capability to manage early pregnancy evaluation.