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Geographic proximity to care in obstetric patients with morbidly adherent placenta: A population-based cohort study
Abstract Number: F3I-359
Abstract Type: Original Research
Background: Morbidly adherent placenta (MAP) is associated with an increased risk of severe maternal morbidity (1). National guidelines recommend that women with MAP deliver at an experienced center with access to multidisciplinary care, which has been shown to improve outcomes (2, 3). Little is known about the availability of such centers, especially for women living in rural or remote areas for whom travel to an appropriate facility may be challenging. The aim of this study was to identify delivery patterns of women with MAP and determine whether geographic proximity to risk-appropriate care affects delivery location.
Methods: In this population-based cohort study, we utilized data from the Health Care Utilization Project’s State Inpatient Database (SID), which included all hospital delivery admissions in six states (FL, NJ, NY, NC, OR, and WA) in 2014. We used a previously validated algorithm to identify all women with MAP who underwent a peripartum hysterectomy (1). Delivery location was characterized by linking the SID to the American Hospital Association’s Annual Survey. We defined an experienced MAP center (EC) as a hospital that performed ≥ 10 annual peripartum hysterectomies based on reported case volumes from recognized ECs (2). The distance from patients’ homes to the nearest EC was approximated using geodetic distance between zip codes. Associations were modelled using multivariable logistic regression.
Results: A total of 362 MAP cases were identified, 42.3% of which delivered at an EC. The median distance from the patients’ homes to an EC was 16.1 miles (25th percentile 5.8 miles, 75th percentile 53.7 miles). Only 14.4% of women living in the farthest quartile from an EC delivered at one compared to 67.8% in the nearest quartile. Patients who lived in the farthest quartile from the nearest EC were 88% less likely to deliver at an EC compared to those living in the closest three quartiles, after adjusting for patient comorbidity burden, race, and income quartile (aOR 0.12, 95% CI 0.06, 0.25).
Conclusion: Women living farthest from an EC were least likely to deliver at a high-volume MAP center, suggesting that geographic location may impede access to appropriate care. Systems should be developed to ensure appropriate referral processes and adequate access to care for women with MAP who live in rural locations.
1. Am J Obstet Gynecol. 2015 Sep;213(3):384.e1-11.
2. Am J Obstet Gynecol. 2015 Feb;212(2):218.e1-9.
3. ACOG Obstetric care consensus: Levels of maternal care.