(963) The Impact of Patient Experiences and Perceptions of Pregnancy Risk on Postpartum Follow Up Patterns

A significant proportion of severe maternal morbidity (SMM) occurs after delivery, but postpartum follow-up is challenged by low patient engagement. This study evaluated whether subjective perceptions of pregnancy risk and/or actual experiences of adverse outcomes impacts participation in postpartum follow up.

Study Design:

This prospective observational study at an urban, academic hospital enrolled a convenience sample of 500 consecutive postpartum patients (6-11/2022). Prior to postpartum discharge, we evaluated patients’ perceptions of their own antenatal risk and experience of peripartum complication (via a survey using Likert scales) and compared these to risks and outcomes derived from the EHR (including obstetric co-morbidity index and SMM).  The primary outcome was attendance at any visit with an obstetric provider within 6 weeks of delivery.

Results:

501 patients participated [(60.7% Black, 6.5% Hispanic, median age 31 (IQR 26-34) median gestational age at delivery 39 wks (IQR 38-39)]. 40.6% delivered by cesarean and median obstetric co-morbidity index (OB-CMI) was 1 (IQR 0-3); 11.6% with high-risk score > 6). 8 patients experienced SMM without transfusion [CDC definition] and 30 had a postpartum hemorrhage. 288 patients (57.5%) attended any visit within 6 weeks postpartum, 80.6% of which were 3-6 weeks postpartum and 64% virtual. There were no differences in attendance of a 6-week postpartum visit based on OB-CMI, incidence of SMM, or subjective descriptions of risk or pregnancy complications (Table).

Conclusion:

Neither perceived risk nor actual complications impacted participation in postpartum care, suggesting that underappreciation of pregnancy-related risk is not a primary driver of postpartum visit attendance. Efforts to optimize postpartum care delivery should target other factors that may contribute to suboptimal follow up, with specific focus on high-risk patients, to prevent morbidity over the extended postpartum period.