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Frequency of Unscheduled Visits to the Obstetrical Triage Assessment Unit by Pregnant Adolescents in an Urban Canadian Centre Compared with a Matched Cohort of Pregnant Women

      Abstract

      Objectives

      People from marginalized and vulnerable populations present more frequently for unscheduled, emergency obstetrical services at labour and delivery triage units. Based on our clinical experience, pregnant adolescents visit the obstetrical triage assessment units (OTAU) more often than adults do. This study was designed to assess this phenomenon by quantifying and describing the frequency of unscheduled visits to the OTAU by pregnant adolescents (age <20 y) compared with a matched cohort of adult pregnant patients (age ≥20 y).

      Methods

      A retrospective database review was performed for data on all adolescent patients that delivered at our institution at ≥20 weeks gestation between January 1, 2013, and December 31, 2017. Adolescent pregnant patients were matched in a 1:1 ratio with adult pregnant patients. Demographic and clinical characteristics as well as the number of visits to the OTAU were recorded.

      Results

      A total of 162 adolescent pregnant patients visited the OTAU during the study period. The mean number of visits to the OTAU by adolescents was 2.77 ± 2.40 compared with 1.96 ± 1.80 visits in the adult cohort (P = 0.0001). Adolescents were 63% more likely than adults to access triage services (incidence rate ratio [IRR] 1.63; 95% CI 1.09–2.44, P = 0.017). Diagnosis of a mental health condition was the only identified risk factor for accessing OTAU, irrespective of age (IRR 1.64; 95% CI 1.05, 2.55, P = 0.029).

      Conclusions

      Adolescent pregnant patients tend to visit the OTAU on an unscheduled basis more often than do adult patients. The presence of a mental health condition was identified as an important predictor of unscheduled visits to OTAUs for adolescent patients.

      Résumé

      Objectifs

      Les personnes issues de populations marginalisées et vulnérables sont plus susceptibles de se présenter au triage de l’unité des naissances pour des services obstétricaux d’urgence et non planifiés. D’après notre expérience clinique, les adolescentes enceintes sont plus susceptibles que les adultes de consulter pour une évaluation au triage obstétrical. Cette étude visait à analyser ce phénomène en quantifiant et en décrivant la fréquence des consultations non planifiées des adolescentes enceintes (< 20 ans) au triage, comparativement à une cohorte appariée de patientes enceintes adultes (≥ 20 ans).

      Méthodologie

      Une analyse rétrospective de la base de données a été effectuée pour les données de toutes les patientes adolescentes ayant accouché dans notre établissement à partir de 20 semaines d’aménorrhée entre le 1er janvier 2013 et le 31 décembre 2017. Les adolescentes enceintes ont été appariées selon un rapport de 1:1 avec les adultes enceintes. Les caractéristiques démographiques et cliniques ainsi que le nombre de consultations au triage obstétrical ont été consignées.

      Résultats

      Au total, 162 adolescentes enceintes se sont présentées au triage obstétrical pendant la période à l’étude. Le nombre moyen de consultations au triage obstétrical par les adolescentes était de 2,77 ± 2,40 comparativement à 1,96 ± 1,80 dans la cohorte adulte (p = 0,0001). Les adolescentes étaient 63 % plus susceptibles que les adultes d’accéder aux services de triage (rapport de taux d’incidence [RTI] : 1,63; IC à 95 % : 1,09–2,44; p = 0,017). Le diagnostic de trouble de santé mentale était le seul facteur de risque relevé pour l’accès au triage obstétrical, peu importe l’âge (RTI : 1,64; IC à 95 % : 1,05–2,55; p = 0,029).

      Conclusions

      Les adolescentes enceintes sont généralement plus susceptibles que les patientes adultes de se rendre au triage obstétrical pour une consultation non planifiée. La présence d’un trouble de santé mentale a été désignée comme un important facteur prédictif des consultations non planifiées par les adolescentes au triage obstétrical.

      Keywords

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      References

        • Koşum Z.
        • Yurdakul M.
        Factors affecting the use of emergency obstetric care among pregnant women with antenatal bleeding.
        Midwifery. 2013; 29: 440-446
        • Angelini D.
        • Howard E.
        Obstetric triage: a systematic review of the past fifteen years: 1998-2013.
        MCN Am J Matern Child Nurs. 2014; 39 (284–97; quiz 298–9)
        • Bloom T.
        • Curry M.A.
        • Durham L.
        Abuse and psychosocial stress as factors in high utilization of medical services during pregnancy.
        Issues Ment Health Nurs. 2007; 28: 849-866
        • Grajkowski A.M.
        • Dolinsky B.M.
        • Abbott J.L.
        • et al.
        The pregnancy "super-utilizer": how does a high-risk depression screen affect medical utilization?.
        J Matern Fetal Neonatal Med. 2017; 30: 1167-1171
        • Kilfoyle K.A.
        • Vrees R.
        • Raker C.A.
        • et al.
        Nonurgent and urgent emergency department use during pregnancy: an observational study.
        Am J Obstet Gynecol. 2017; 216: 181
        • United Nations Population Fund
        State of the world population 2011.
        (Available at:) (Accessed on May 30, 2021)
        • Paranjothy S.
        • Broughton H.
        • Adappa R.
        • et al.
        Teenage pregnancy: who suffers?.
        Arch Dis Child. 2009; 94: 239-245
        • Ontario Ministry of Health and Long-Term Care
        Initial report on public health.
        (Available at:) (Accessed on June 7, 2021)
        • Malabarey O.T.
        • Balayla J.
        • Klam S.L.
        • et al.
        Pregnancies in young adolescent mothers: a population-based study on 37 million births.
        J Pediatr Adolesc Gynecol. 2012; 25: 98-102
        • Quinlivan J.A.
        • Evans S.F.
        Teenage antenatal clinics may reduce the rate of preterm birth: a prospective study.
        BJOG. 2004; 111: 571-578
        • Fleming N.A.
        • Tu X.
        • Black A.Y.
        Improved obstetrical outcomes for adolescents in a community-based outreach program: a matched cohort study.
        J Obstet Gynaecol Can. 2012; 34: 1134-1140
        • Lena S.M.
        • Marko E.
        • Nimrod C.
        • et al.
        Birthing experience of adolescents at the Ottawa General Hospital Perinatal Centre.
        CMAJ. 1993; 148: 2149-2154
      1. Public Health Analytic Reporting Tool (Cube), BORN Information System (BIS), BORN Ontario. Information accessed on March 17–18, 2018.

      2. R Core Team (2019). R: A language and environment for statistical computing.
        (Available at:) (Accessed April 12, 2019)
        • Mehta P.K.
        • Carter T.
        • Vinoya C.
        • et al.
        Understanding high utilization of unscheduled care in pregnant women of low socioeconomic status.
        Womens Health Issues. 2017; 27: 441-448
        • Fleming N.
        • O'Driscoll T.
        • Becker G.
        • et al.
        Adolescent pregnancy guidelines.
        J Obstet Gynaecol Can. 2015; 37: 740-756
        • Thomas D.V.
        • Looney S.W.
        Effectiveness of a comprehensive psychoeducational intervention with pregnant and parenting adolescents: a pilot study.
        J Child Adolesc Psychiatr Nurs. 2004; 17: 66-77
        • Li D.
        • Liu L.
        • Odouli R.
        Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study.
        Hum Reprod. 2009; 24: 146-153
        • Diego M.A.
        • Field T.
        • Hernandez-Reif M.
        • et al.
        Prenatal depression restricts fetal growth.
        Early Hum Dev. 2009; 85: 65-70
        • Davalos D.B.
        • Yadon C.A.
        • Tregellas H.C.
        Untreated prenatal maternal depression and the potential risks to offspring: a review.
        Arch Womens Ment Health. 2012; 15: 1-14
        • Kabir K.
        • Sheeder J.
        • Stevens-Simon C.
        Depression, weight gain, and low birth weight adolescent delivery: do somatic symptoms strengthen or weaken the relationship?.
        J Pediatr Adolesc Gynecol. 2008; 21: 335-342
        • Siegel R.S.
        • Brandon A.R.
        Adolescents, pregnancy, and mental health.
        J Pediatr Adolesc Gynecol. 2014; 27: 138-150
        • Hodgkinson S.
        • Beers L.
        • Southammakosane C.
        • et al.
        Addressing the mental health needs of pregnant and parenting adolescents.
        Pediatrics. 2014; 133: 114-122