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Comorbidities among women presenting to the ED with OB/GYN complaints

Cosby, Caitlin
Dawson, Charlee
Tewari, Shannon
Hartwell, Micah
Background: The management of obstetric and gynecological emergencies are focused on the conservation of fertility and sexual function. Common OBGYN emergencies can cause pregnancy complications in the present or future and should be taken into consideration in all women presenting to the emergency department with related complaints. Common comorbidities such as hypertension, diabetes and more can precede OBGYN complications that subsequently can lead to pregnancy complications. Our primary objective was to use the National Hospital Ambulatory Medical Care Survey (NHAMCS) to assess the diagnostics and comorbidities among women who utilize the ED for obstetric and gynecologic care. Secondary objectives are to compare demographics and comorbidities among women who are insured versus uninsured, by region, and urbanicity.
Methods: We conducted a cross-sectional analysis for the 2021 NHAMCS to determine rates of comorbidities among women presenting to the ED for obstetric and gynecologic care. Included in our study are women who presented to the ED for obstetric care identified by ICD-10 diagnostic codes starting with O- and select Z- codes reported within any 5 potential diagnoses each participant could have been given. Individuals who were male, nonpregnant, or pregnant but did not have an OB/GYN-related ICD-10 code were excluded from the study. Data extracted included comorbidities, insurance status, ethnicity, age, region, and urban versus rural areas.
Results: Our sample consisted of 446 women aged 16-47. The average age was 27.5 years for women with no comorbidities and 28.8 for women that have a comorbidity. Asthma and Depression were the most common comorbidities reported with 14.35 and 11.59 weighted percentages respectively. Hypertension had a weighted percentage of 8.84%, followed by Substance Abuse or Dependence at 7.56% and Obesity at 7.27%. Any type of Diabetes fell at 5.08%, with all other comorbidities below 1.5%. Of the women included, 40.19% were Non-Hispanic White, 38.42% were Non-Hispanic Black, and 17.34% were Hispanic. There was no statistically significant difference (F (2.61, 221.68) = 1.6530 P = 0.1845) in the presence of comorbidities among ethnicities. Medicaid was the most prevalent insurance reported at 56.35%. However, there was no difference in insurance status and comorbidities (F (4.00, 339.99) = 1.6947 P = 0.1508) present. The Midwest in comparison to the other regions had a higher prevalence of comorbidities (F (2.85, 242.16) = 4.1640 P = 0.0077) present among women. There was no difference in metropolitan versus nonmetropolitan areas and the presence of comorbidities in our sample population.
Conclusions: Women presenting to the emergency department with OBGYN complaints are more likely to have Asthma, Depression or Hypertension as a comorbidity. This should be taken into consideration when assessing OBGYN patients in the emergency department and the effects it can have on pregnancy and future fertility of women. The Midwest region had the highest percentage of comorbidities among all the regions. There were no other significant factors having influence on the presence of comorbidities. Further efforts to determine influences on comorbidities in women presenting to the ED with OBGYN complaints should be conducted to properly treat and prevent further pregnancy complications.