Abstract
Importance: Hospital closures and the increasing lack of maternity care in rural areas is leading to greater distances traveled for obstetric care, delivery and specialized obstetric care particularly in rural areas of the United States.
Objectives: The aim of this study was to update management of in a tertiary obstetric center and review the literature on antenatal management of high-risk pregnancies on an outpatient versus and in-patient basis.
Evidence Acquisition: Electronic databases (PubMed, OVID, and EMBASE) were searched from 1990 – 9/20204 for English language abstracts. Studies were selected which examined outpatient compared with inpatient management of pregnancy at risk for adverse maternal and/or perinatal outcomes.
Results: The evolution of our program from the first publication that covered 9/2007 to 12/2012 is updated thru 12/20/23. Basic services, admitting diagnosis, costs, maternal fetal outcomes, benefits and drawbacks to patients and families and new developments are brought up to date. Our literature review identified 282 abstracts of which 28 articles became the basis of this review. Pregnancy outcomes comparing inpatient versus outpatient management include hypertension, preterm premature rupture of the membranes, preterm labor, diabetes, hyperemesis gravidarum, cost psychological impact, and satisfaction.
Conclusions: Our outpatient program has evolved since 2012 into a low cost efficient monitoring program for our referred high risk pregnancies. A review of outpatient/day care units demonstrates that they can safely provide monitoring for high-risk pregnancies.