Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Walter, M.A.; Alvarado, M.S. Clinical Aspects of Miscarriage. MCN Am. J. Matern. Child Nurs. 2018, 43, 6–12. [Google Scholar] [CrossRef]
- Norton, W.; Furber, L. An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: An interpretive phenomenological analysis. BMJ Open. 2018, 8, e023579. [Google Scholar] [CrossRef]
- Emond, T.; de Montigny, F.; Guillaumie, L. Exploring the needs of parents who experience miscarriage in the emergency department: A qualitative study with parents and nurses. J. Clin. Nurs. 2019, 28, 1952–1965. [Google Scholar] [CrossRef] [PubMed]
- Punches, B.E.; Johnson, K.D.; Acquavita, S.P.; Felblinger, D.M.; Gillespie, G.L. Patient perspectives of pregnancy loss in the emergency department. Int. Emerg. Nurs. 2019, 43, 61–66. [Google Scholar] [CrossRef]
- Çevik Ateş, A.; Topatan, S. The relationship between support systems and anxiety in couples admitted to the emergency department with vaginal bleeding. Int. Emerg. Nurs. 2019, 46, 100781. [Google Scholar] [CrossRef]
- MacWilliams, K.; Hughes, J.; Aston, M.; Field, S.; Moffatt, F.W. Understanding the Experience of Miscarriage in the Emergency Department. J. Emerg. Nurs. 2016, 42, 504–512. [Google Scholar] [CrossRef]
- Freeman, A.; Neiterman, E.; Varathasundaram, S. Women’s experiences of health care utilization in cases of early pregnancy loss: A scoping review. Women Birth. 2021, 34, 316–324. [Google Scholar] [CrossRef]
- Miller, C.A.; Roe, A.; McAllister, A.; Meisel, Z.F.; Koelper, N.; Schreiber, C.A. Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings. Obstet. Gynecol. 2019, 134, 1285–1292. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- de Montigny, F.; Verdon, C.; Dubeau, D.; Devault, A.; St-André, M.; Tchouaket Nguemeleu, É.; Lacharité, C. Protocol for evaluation of the continuum of primary care in the case of a miscarriage in the emergency room: A mixed-method study. BMC Pregnancy Childbirth. 2017, 17, 124. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Adolfsson, A.; Tullander-Tjörnstrand, K.; Larsson, P.G. Decreased need for emergency services after changing management for suspected miscarriage. Acta Obstet. Gynecol. Scand. 2011, 90, 921–923. [Google Scholar] [CrossRef]
- Yang, J.; Savitz, D.A.; Dole, N.; Hartmann, K.E.; Herring, A.H.; Olshan, A.F.; Thorp, J.M., Jr. Predictors of vaginal bleeding during the first two trimesters of pregnancy. Paediatr. Perinat. Epidemiol. 2005, 19, 276–283. [Google Scholar] [CrossRef] [PubMed]
- Rashad, W.A.; Essa, R.M. Women’s Awareness of Danger Signs of Obstetrics Complications. J. Am. Sci. 2010, 6, 1299–1306. [Google Scholar] [CrossRef]
- Emergency Medicine Act of September 8, 2006. J. Laws 2020, 882. Available online: https://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20200000882/T/D20200882L.pdf (accessed on 4 August 2021). (In Polish).
- System Wspomagania Dowodzenia Państwowego Ratownictwa Medycznego (SWD PRM)/National Monitoring Center of Emergency Medical Services. Available online: https://www.gov.pl/web/zdrowie/system-wspomagania-dowodzenia-panstwowego-ratownictwa-medycznego-swd-prm- (accessed on 4 August 2021) (In Polish).
- Dhaded, S.M.; Somannavar, M.S.; Jacob, J.P.; McClure, E.M.; Vernekar, S.S.; Yogesh Kumar, S.; Kavi, A.; Ramadurg, U.Y.; Moore, J.L.; Wallace, D.P.; et al. Early pregnancy loss in Belagavi, Karnataka, India 2014–2017: A prospective population-based observational study in a low-resource setting. Reprod. Health 2018, 15 (Suppl. 1), 95. [Google Scholar] [CrossRef]
- Varner, C.E.; Park, A.L.; Little, D.; Ray, J.G. Emergency department use by pregnant women in Ontario: A retrospective population-based cohort study. CMAJ Open. 2020, 8, E304–E312. [Google Scholar] [CrossRef]
- Baird, S.; Gagnon, M.D.; de Fiebre, G.; Briglia, E.; Crowder, R.; Prine, L. Women’s experiences with early pregnancy loss in the emergency room: A qualitative study. Sex Reprod. Healthc. 2018, 16, 113–117. [Google Scholar] [CrossRef] [PubMed]
- Koşum, Z.; Yurdakul, M. Factors affecting the use of emergency obstetric care among pregnant women with antenatal bleeding. Midwifery 2013, 29, 440–446. [Google Scholar] [CrossRef]
- Cox, R.; Khalid, S.; Brierly, G.; Forsyth, A.; McNamara, R.; Heppell, V.; Granne, I. Implementing a community model of early pregnancy care. BMC Health Serv. Res. 2020, 20, 664. [Google Scholar] [CrossRef]
- Wierzbik-Strońska, M.; Nadolny, K.; Grabarek, B.O.; Boroń, D. Characteristics of the Intervention of Emergency Medical Teams in the Southern part of Poland in 12-Month Observation. Wiad. Lek. 2020, 73, 1632–1636. [Google Scholar] [CrossRef] [PubMed]
- Strehlow, M.C.; Newberry, J.A.; Bills, C.B.; Min, H.E.; Evensen, A.E.; Leeman, L.; Pirrotta, E.A.; Rao, G.V.; Mahadevan, S.V. Characteristics and outcomes of women using emergency medical services for third- trimester pregnancy-related problems in India: A prospective observational study. BMJ Open 2016, 6, e011459. [Google Scholar] [CrossRef]
- Bills, C.B.; Newberry, J.A.; Darmstadt, G.; Pirrotta, E.A.; Rao, G.V.R.; Mahadevan, S.V.; Strehlow, M.C. Reducing early infant mortality in India: Results of a prospective cohort of pregnant women using emergency medical services. BMJ Open 2018, 8, e019937. [Google Scholar] [CrossRef] [Green Version]
- Freitas, V.C.A.; Quirino, G.S.; Giesta, R.P.; Pinheiro, A.K.B. Clinical and obstetric situation of pregnant women who require prehospital emergency care. Rev. Bras. Enferm 2020, 73 (Suppl. 4), e20190058. [Google Scholar] [CrossRef]
- Zhou, H.; Liu, Y.; Liu, L.; Zhang, M.; Chen, X.; Qi, Y. Maternal pre-pregnancy risk factors for miscarriage from a prevention perspective: A cohort study in China. Eur. J. Obstet. Gynecol. Reprod. Biol. 2016, 206, 57–63. [Google Scholar] [CrossRef] [PubMed]
- Feodor Nilsson, S.; Andersen, P.K.; Strandberg-Larsen, K.; Nybo Andersen, A.M. Risk factors for miscarriage from a prevention perspective: A nationwide follow-up study. BJOG 2014, 121, 1375–1384. [Google Scholar] [CrossRef]
- Magnus, M.C.; Wilcox, A.J.; Morken, N.H.; Weinberg, C.R.; Håberg, S.E. Role of maternal age and pregnancy history in risk of miscarriage: Prospective register based study. BMJ 2019, 20, l869. [Google Scholar] [CrossRef] [Green Version]
- Oliveira, M.T.S.; Oliveira, C.N.T.; Marques, L.M.; Souza, C.L.; Oliviera, M.V. Factors associated with spontaneous abortion: A systematic review. Rev. Bras. Saude Mater. Infant. 2020, 20, 361–372. [Google Scholar] [CrossRef]
- Rzońca, E.; Bień, A.; Gotlib, J.; Gałązkowski, R. Bleeding during pregnancy as a reason for interventions by emergency medical services teams in Poland. Ann. Agric. Environ. Med. 2021. [Google Scholar] [CrossRef]
- Rozkrut, D. Demographic Yearbook of Poland; Statistics Poland: Warsaw, Poland, 2020. [Google Scholar]
Age—M (SD) | 30.53 (6.76) |
Number of pregnancies—n (%) | |
1st | 890 (48.90) |
2nd | 393 (21.59) |
3rd or more | 537 (29.51) |
Number of pregnancies—M (SD) | 2.08 (1.42) |
Gestational week—n (%) | |
≤13 weeks | 1395 (76.65) |
≥14 weeks | 425 (23.35) |
Gestational week—M (SD) | 10.79 (4.15) |
Number of previous deliveries—n (%) | |
0 | 916 (50.33) |
1–2 | 438 (24.07) |
3 or more | 466 (25.60) |
Number of previous deliveries—M (SD) | 1.43 (1.70) |
History of miscarriage—n (%) | |
Yes | 158 (8.68) |
No | 1662 (91.32) |
Symptoms—n (%) | |
Bleeding | 1469 (80.71) |
Abdominal pain | 792 (43.52) |
Spotting | 220 (12.09) |
Contractions | 161 (8.85) |
Vomiting | 60 (3.30) |
Diarrhea | 19 (1.04) |
Time of Year—n (%) | |
Spring | 438 (24.07) |
Summer | 452 (24.84) |
Fall | 438 (24.07) |
Winter | 492 (27.03) |
Time of call—n (%) | |
7 A.M.–6.59 P.M. | 944 (51.87) |
7 P.M.–6.59 A.M. | 876 (48.13) |
Location of call—n (%) | |
Urban area | 1260 (69.23) |
Rural area | 560 (30.77) |
Urgency code—n (%) | |
Code 1 | 808 (44.40) |
Code 2 | 1012 (55.60) |
EMS team type—n (%) | |
Non-physician-staffed | 1076 (59.12) |
Physician-staffed | 744 (40.88) |
EMS team composition—n (%) | |
Two-person | 870 (47.80) |
Three-person | 950 (52.20) |
Medical emergency procedures—n (%) | |
Blood pressure measurement | 1726 (94.84) |
Pulse oximetry | 1686 (92.64) |
Physical examination | 1267 (69.62) |
Intravenous cannulation | 939 (51.59) |
Blood glucose measurement | 511 (28.08) |
Intravenous medication | 439 (24.12) |
Fluid therapy | 428 (23.52) |
Analgesic treatment | 97 (5.33) |
Gynecological examination | 81 (4.45) |
Selected physical examination findings—M (SD) | |
Heart rate | 94.12 (17.06) |
Mean arterial pressure | 99.68 (14.76) |
Respiration rate | 16.05 (4.18) |
Saturation | 97.93 (1.21) |
Blood glucose | 114.64 (37.10) |
1 GCS | 14.96 (0.57) |
2 RTS | 11.95 (0.30) |
Further management—n (%) | |
Patient transferred to hospital | 1775 (97.53) |
Patient left in place | 45 (2.47) |
Total intervention duration (min)—M (SD) | 40.82 (16.59) |
Variables | EMS Team Type | p-Value | Location of Call | p-Value | ||
---|---|---|---|---|---|---|
Non-Physician-Staffed | Physician-Staffed | Urban Area | Rural Area | |||
Age—M (SD) | 30.57 (6.94) | 30.47 (6.51) | 0.9229 | 30.29 (6.85) | 31.06 (6.53) | 0.0283 |
Time of call—n (%) | ||||||
7 A.M.–6.59 P.M. | 564 (52.42) | 380 (51.08) | 0.5735 | 663 (52.62) | 281 (50.18) | 0.3362 |
7 P.M.–6.59 A.M. | 512 (47.58) | 364 (48.92) | 597 (47.38) | 279 (49.82) | ||
Location of call n (%) | ||||||
Urban area | 757 (70.35) | 503 (67.61) | 0.2122 | - | - | - |
Rural area | 319 (29.65) | 241 (32.39) | - | - | ||
Urgency code—n (%) | ||||||
Code 1 | 417 (38.75) | 391 (52.55) | 0.0000 | 537 (42.62) | 271 (48.39) | 0.0221 |
Code 2 | 659 (61.25) | 353 (47.45) | 723 (57.38) | 289 (51.61) | ||
EMS team composition—n (%) | ||||||
Two-person | 820 (76.21) | 50 (6.72) | 0.0000 | 597 (47.38) | 273 (48.75) | 0.5894 |
Three-person | 256 (23.79) | 694 (93.28) | 663 (52.62) | 287 (51.25) | ||
Further management—n (%) | ||||||
Assistance provided, patient transferred to hospital | 1041 (96.75) | 734 (98.66) | 0.0099 | 1222 (96.98) | 553 (98.75) | 0.0251 |
Patient left in place | 35 (3.25) | 10 (1.34) | 38 (3.02) | 7 (1.25) | ||
Intervention duration (min)—M (SD) | 42.55 (16.88) | 38.35 (15.87) | 0.0000 | 36.77 (15.40) | 49.80 (15.59) | 0.0000 |
Variables | Gestational Week | p-Value | Number of Pregnancies | p-Value | Number of Previous Deliveries | p-Value | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
≤13 Weeks | 14 or More | 1st | 2nd | 3rd or More | None | 1–2 | 3 or More | ||||
Age—M (SD) | 30.57 (6.86) | 30.39 (6.44) | 0.6413 | 29.38 (7.13) | 30.03 (6.24) | 32.78 (5.92) | 0.0000 | 29.47 (7.10) | 30.06 (6.25) | 33.04 (5.86) | 0.0000 |
History of miscarriage—n (%) | |||||||||||
Yes | 94 (6.74) | 64 (15.06) | 0.0000 | 0 (0.00) | 40 (10.18) | 118 (21.97) | 0.0000 | 40 (4.37) | 71 (16.21) | 47 (10.09) | 0.0000 |
No | 1301 (93.26) | 361 (84.94) | 890 (100.00) | 353 (89.82) | 419 (78.03) | 876 (95.63) | 367 (83.79) | 419 (89.91) | |||
Location of call—n (%) | |||||||||||
Urban area | 975 (69.89) | 285 (67.06) | 0.2678 | 651 (73.15) | 278 (70.74) | 331 (61.64) | 0.0000 | 673 (73.47) | 301 (68.72) | 286 (61.37) | 0.0000 |
Rural area | 420 (30.11) | 140 (32.94) | 239 (26.85) | 115 (29.26) | 206 (38.36) | 243 (26.53) | 137 (31.28) | 180 (38.63) | |||
Urgency code—n (%) | |||||||||||
Code 1 | 565 (40.50) | 243 (57.18) | 0.0000 | 357 (40.11) | 189 (48.09) | 262 (48.79) | 0.0015 | 374 (40.83) | 206 (47.03) | 228 (48.93) | 0.0073 |
Code 2 | 830 (59.50) | 182 (42.82) | 533 (59.89) | 204 (51.91) | 275 (51.21) | 542 (59.17) | 232 (52.97) | 238 (51.07) | |||
EMS team type—n (%) | |||||||||||
Non-physician-staffed | 841 (60.29) | 235 (55.29) | 0.0668 | 555 (62.36) | 222 (56.49) | 299 (55.68) | 0.0221 | 574 (62.66) | 247 (56.39) | 255 (54.72) | 0.0073 |
Physician-staffed | 554 (39.71) | 190 (44.71) | 335 (37.64) | 171 (43.51) | 238 (44.32) | 342 (37.34) | 191 (43.61) | 211 (45.28) |
Variables | Gestational Week | p-Value | Number of Pregnancies | p-Value | Number of Previous Deliveries | p-Value | |||||
---|---|---|---|---|---|---|---|---|---|---|---|
≤13 Weeks | 14 or More | 1st | 2nd | 3rd or More | None | 1–2 | 3 or more | ||||
Number of pregnancies | r = 0.182 | 0.0000 | - | - | - | - | |||||
Number of previous deliveries | r = 0.159 | 0.0000 | r = 0.945 | 0.0000 | - | - | |||||
Selected physical examination findings | |||||||||||
Heart rate | r = 0.068 | 0.0048 | r = 0.020 | 0.3963 | r = 0.010 | 0.6910 | |||||
MAP | r = 0.040 | 0.0978 | r = 0.072 | 0.0031 | r = 0.057 | 0.0196 | |||||
Respiration rate | r = 0.055 | 0.0225 | r = 0.026 | 0.2857 | r = 0.024 | 0.3257 | |||||
Saturation | r = −0.058 | 0.0185 | r = 0.004 | 0.8836 | r = 0.004 | 0.8819 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Rzońca, E.; Bień, A.; Bączek, G.; Rzońca, P.; Filip, M.; Gałązkowski, R. Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study. Int. J. Environ. Res. Public Health 2021, 18, 12305. https://doi.org/10.3390/ijerph182312305
Rzońca E, Bień A, Bączek G, Rzońca P, Filip M, Gałązkowski R. Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study. International Journal of Environmental Research and Public Health. 2021; 18(23):12305. https://doi.org/10.3390/ijerph182312305
Chicago/Turabian StyleRzońca, Ewa, Agnieszka Bień, Grażyna Bączek, Patryk Rzońca, Michał Filip, and Robert Gałązkowski. 2021. "Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study" International Journal of Environmental Research and Public Health 18, no. 23: 12305. https://doi.org/10.3390/ijerph182312305