Background: In the US, the increase in pre-existing maternal conditions and aging of the maternal population has resulted in a shift towards indirect causes of maternal morbidity and mortality. Indirect causes of morbidity and mortality result from previous existing disease or disease that developed during pregnancy and which were not due to direct obstetric causes, but which were aggravated by physiologic effects of pregnancy.
Obstetric Medicine, a subspecialty of internal medicine, is thus emerging as an important consultative service for addressing and managing medical problems of pregnancy and the consequences of pregnancy complications.
At Bridgeport Hospital, a community hospital in Connecticut with 3000 deliveries per year and serving a complex urban obstetric population, we are developing a consultative Obstetric Medicine service within the Hospitalist program and in close collaboration with the department of Obstetrics & Gynecology.
In order to design an effective program, we sought to:
1. determine the proportion of women who have a pre-existing medical condition or develop a medical condition during pregnancy or the postpartum period
2. describe the types of medical conditions encountered in our obstetric population
Methods: Using pre-specified ICD-10 codes for maternal medical conditions, we identified women with at least one medical condition as their primary or secondary diagnosis [either pre-existing or developing in pregnancy or in the postpartum women] admitted to the Women’s Care Centre between July-Sep 2018. Each diagnosis was then independently reviewed by two of the authors [ASG and TF] to ensure relevance and appropriateness. While the unit does not routinely track the number of antepartum admission, we estimated an average of 240 total admissions [antepartum and postpartum] per month.
Results: During our study period, 209 women were identified as having a medical condition. 106 [51 %] of women had pre-existing medical conditions (34% of them had ≥2 diagnoses) and 152 [73 %] of women had medical conditions that arose during pregnancy or the postpartum period (27% of them had ≥2 diagnoses). 49 women [23%] had pre-existing conditions and developed pregnancy specific medical conditions.
The most common pre-existing medical conditions were chronic hypertension diabetes, hypothyroidism, and asthma. While a number of medical conditions arose during pregnancy and the postpartum period, pre-eclampsia and its complications, gestational diabetes, and infectious diseases were the most common conditions.
Conclusions: Our study confirms that a significant proportion of the obstetric population at our centre have either pre-existing medical conditions or develop medical complications during pregnancy and the postpartum period. A dedicated Obstetric Medicine consultative service can provide the necessary expertise to manage this select patient population.