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Prospective study to investigate the reporting of comorbid diseases in a cohort of laboring women in a large tertiary medical center
Abstract Number: T1A-55
Abstract Type: Original Research
Background: Comorbidities are a leading cause of maternal morbidity and mortality. In Israel, antenatal care is fragmented between community and hospital, and medical information is not conveyed automatically between these isolated platforms. We aimed to evaluate the frequency of reported comorbidities in laboring women: 1) in the community electronic medical records (EMR) 2) the hospital EMR, 3) history taken by anesthesiologist during labor and 4) postpartum interview.
Methods: Prospective descriptive cohort study (Apr-Sept2017) in a large tertiary hospital; women consented postpartum to a search for demographic, obstetric and medical comorbidities reported in: community and hospital EMR, anesthesiologist history, a postpartum interview with an experienced anesthesiologist. We used two variables with high predictive value (0.85) for severe maternal morbidity during delivery: ≥4 packed red blood cells (PRBC) and intensive care unit (ICU) admission during pregnancy or after delivery.
Results: We interviewed 263 women. Distribution of comorbidities (most severe only for each woman) is shown in Figure 1. Table 1 presents frequencies of all recorded comorbidities. The hospital EMR and anesthesiologist missed many diagnoses reported in the community EMR; the most frequently under-reported were musculoskeletal and neurologic diagnoses. One woman did not report familial cholinesterase deficiency; another reported diplopia while failing to report the recent severe multi-trauma motor vehicle accident that caused it. Women did not report all community diagnoses in the postpartum interview. Six women were hospitalized in the ICU (4 healthy women after for PPH; 2 with comorbidities for preeclampsia). Two healthy women and one with comorbidities received ≥4 PRBC units.
Conclusions: Maternal comorbidities were unreported by women thus unknown to the clinicians during delivery. Musculoskeletal and neurologic diagnoses were the most frequently unreported diagnoses. The most robust source for medical diagnoses was the community EMR. However requiring physicians to search every patient's community EMR is a burden. Privacy and costs limit automatic transfer of reported diagnoses from the community to hospital EMRs. The pre-anesthesia evaluation clinic could bridge this gap between community and hospital care but requires significant manpower and women may be unaware of its existence and the need for assessment.