Outpatient Monitoring of High Risks Pregnancies: An Update of Management in a Tertiary Obstetric Center and Review of the Literature
Main Article Content
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.
Keywords:
High-risk pregnancies, Outpatient monitoring, Tertiary obstetric center, Maternal-fetal outcomes, Inpatient vs outpatient care, Pregnancy complications, Cost-effective monitoring
Article Details
How to Cite
CHOI-KLIER, Joanna I et al.
Outpatient Monitoring of High Risks Pregnancies: An Update of Management in a Tertiary Obstetric Center and Review of the Literature.
Medical Research Archives, [S.l.], v. 12, n. 12, dec. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6086>. Date accessed: 06 jan. 2025.
doi: https://doi.org/10.18103/mra.v12i12.6086.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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11. Bivins, H. A., Jr, McCallum, O. J., & Roegge, D. D. (2007). The Mother's House: a new concept in antepartum care. American journal of obstetrics and gynecology, 197(2), 201.e1–201.e201004. https://doi.org/10.1016/j.ajog.2007.04.045
12. Droste, S., & Keil, K. (1994). Expectant management of placenta previa: cost-benefit analysis of outpatient treatment. American journal of obstetrics and gynecology, 170(5 Pt 1), 1254–1257. https://doi.org/10.1016/s0002-9378(94)70136-9
13. Wing, D. A., Paul, R. H., & Millar, L. K. (1996). Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. American journal of obstetrics and gynecology, 175(4 Pt 1), 806–811. https://doi.org/10.1016/s0002-9378(96)80003-2
14. Ambrose, S., Rhea, D. J., Istwan, N. B., Collins, A., & Stanziano, G. (2004). Clinical and economic outcomes of preterm labor management: inpatient vs outpatient. Journal of perinatology : official journal of the California Perinatal Association, 24(8), 515–519. https://doi.org/10.1038/sj.jp.7211139
15. Bekker, M. N., Koster, M. P. H., Keusters, W. R., Ganzevoort, W., de Haan-Jebbink, J. M., Deurloo, K. L., Seeber, L., van der Ham, D. P., Zuithoff, N. P. A., Frederix, G. W. J., van den Heuvel, J. F. M., & Franx, A. (2023). Home telemonitoring versus hospital care in complicated pregnancies in the Netherlands: a randomised, controlled non-inferiority trial (HoTeL). The Lancet. Digital health, 5(3), e116–e124. https://doi.org/10.1016/S2589-7500(22)00231-X
16. Dowswell, T., Middleton, P., & Weeks, A. (2009). Antenatal day care units versus hospital admission for women with complicated pregnancy. The Cochrane database of systematic reviews, 2009(4), CD001803. https://doi.org/10.1002/14651858.CD001803.pub2
17. Twaddle S. (1995). Day care for women with high-risk pregnancies. Nursing times, 91(4), 46–47.
18. Giannubilo, S. R., Bezzeccheri, V., Landi, B., Battistoni, G. I., Stortoni, P., Vitali, P., & Tranquilli, A. L. (2012). PP047. Outpatient management of pregnancy complicated by mild hypertensive disorders. Pregnancy hypertension, 2(3), 267. https://doi.org/10.1016/j.preghy.2012.04.158
19. Barton, J. R., Istwan, N. B., Rhea, D., Collins, A., & Stanziano, G. J. (2006). Cost-savings analysis of an outpatient management program for women with pregnancy-related hypertensive conditions. Disease management: DM, 9(4), 236–241. https://doi.org/10.1089/dis.2006.9.236
20. Dunlop, L., Umstad, M., McGrath, G., Reidy, K., & Brennecke, S. (2003). Cost-effectiveness and patient satisfaction with pregnancy day care for hypertensive disorders of pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology, 43(3), 207–212. https://doi.org/10.1046/j.0004-8666.2003.00061.x
21. Cavassini, A. C., Lima, S. A., Calderon, I. M., & Rudge, M. V. (2012). Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil. Sao Paulo medical journal = Revista paulista de medicina, 130(1), 17–26. https://doi.org/10.1590/s1516-31802012000100004
22. Alalade, A. O., Khan, R., & Dawlatly, B. (2007). Day-case management of hyperemesis gravidarum: Feasibility and clinical efficacy. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 27(4), 363–364. https://doi.org/10.1080/01443610701327396
23. McCarthy, F. P., Murphy, A., Khashan, A. S., McElroy, B., Spillane, N., Marchocki, Z., Sarkar, R., & Higgins, J. R. (2014). Day care compared with inpatient management of nausea and vomiting of pregnancy: a randomized controlled trial. Obstetrics and gynecology, 124(4), 743–748. https://doi.org/10.1097/AOG.0000000000000449
24. Murphy, A., McCarthy, F. P., McElroy, B., Khashan, A. S., Spillane, N., Marchocki, Z., Sarkar, R. K., & Higgins, J. R. (2016). Day care versus inpatient management of nausea and vomiting of pregnancy: cost utility analysis of a randomised controlled trial. European journal of obstetrics, gynecology, and reproductive biology, 197, 78–82. https://doi.org/10.1016/j.ejogrb.2015.10.022
25. Heaman, M., & Gupton, A. (1998). Perceptions of bed rest by women with high-risk pregnancies: A comparison between home and hospital. Birth (Berkeley, Calif.), 25(4), 252–258. https://doi.org/10.1046/j.1523-536x.1998.00252.x
26. Turnbull, D. A., Wilkinson, C., Gerard, K., Shanahan, M., Ryan, P., Griffith, E. C., Kruzins, G., & Stamp, G. E. (2004). Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. Lancet (London, England), 363(9415), 1104–1109. https://doi.org/10.1016/S0140-6736(04)15893-5
27. Walker J. J. (1993). Day care obstetrics. British journal of hospital medicine, 50(5), 225–226.
28. Figà-Talamanca I. (1996). Maternal mortality and the problem of accessibility to obstetric care; the strategy of maternity waiting homes. Social science & medicine (1982), 42(10), 1381–1390. https://doi.org/10.1016/0277-9536(95)00286-3
2. Stoneburner A, Lucas R, Fontenot J, Brigance C, Jones E, DeMaria AL. Nowhere to Go: Maternity Care Deserts Across the US. (Report No 4). March of Dimes. 2024. https://www.marchofdimes.org/ maternity-care-deserts-report
3. Gazmararian, J. A., Petersen, R., Jamieson, D. J., Schild, L., Adams, M. M., Deshpande, A. D., & Franks, A. L. (2002). Hospitalizations during pregnancy among managed care enrollees. Obstetrics and gynecology, 100(1), 94–100. https://doi.org/10.1016/s0029-7844(02)02024-0
4. Hughes, D. S., Ussery, D. J., Woodruff, D. L., Sandlin, A. T., Kinder, S. R., & Magann, E. F. (2015). The continuing antenatal management program (CAMP): Outpatient monitoring of high-risk pregnancies. Keeps patients safe, costs low and care nearby. Sexual & reproductive healthcare: official journal of the Swedish Association of Midwives, 6(2), 108–109. https://doi.org/10.1016/j.srhc.2015.01.001
5. Dowswell, T., Middleton, P., & Weeks, A. (2009). Antenatal day care units versus hospital admission for women with complicated pregnancy. The Cochrane database of systematic reviews, 2009(4), CD001803. https://doi.org/10.1002/14651858.CD001803.pub2
6. Dexter, S. C., Klein, K. A., Clark, D. A., Ross, S. L., & Veille, J. C. (2004). The Ronald McDonald House as an alternative to antepartum hospitalization. Journal of perinatology : official journal of the California Perinatal Association, 24(10), 623–625. https://doi.org/10.1038/sj.jp.7211166
7. van Lonkhuijzen, L., Stegeman, M., Nyirongo, R., & van Roosmalen, J. (2003). Use of maternity waiting home in rural Zambia. African journal of reproductive health, 7(1), 32–36.
8. Hossain, Semonti K. BS; Porter, Emily L. BA; Redden, Lisa M. BA; Pearlmutter, Mark D. MD. Maternity Waiting Home Use and Maternal Mortality in Milot, Haiti. Obstetrics & Gynecology 123():p 149S, May 2014. | DOI: 10.1097/01.AOG. 0000447136.92802.2a
9. Gorry C. (2011). Cuban maternity homes: a model to address at-risk pregnancy. MEDICC review, 13(3), 12–15. https://doi.org/10.37757/MR2011V13.N3.4
10. Chandramohan, D., Cutts, F., & Millard, P. (1995). The effect of stay in a maternity waiting home on perinatal mortality in rural Zimbabwe. The Journal of tropical medicine and hygiene, 98(4), 261–267.
11. Bivins, H. A., Jr, McCallum, O. J., & Roegge, D. D. (2007). The Mother's House: a new concept in antepartum care. American journal of obstetrics and gynecology, 197(2), 201.e1–201.e201004. https://doi.org/10.1016/j.ajog.2007.04.045
12. Droste, S., & Keil, K. (1994). Expectant management of placenta previa: cost-benefit analysis of outpatient treatment. American journal of obstetrics and gynecology, 170(5 Pt 1), 1254–1257. https://doi.org/10.1016/s0002-9378(94)70136-9
13. Wing, D. A., Paul, R. H., & Millar, L. K. (1996). Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. American journal of obstetrics and gynecology, 175(4 Pt 1), 806–811. https://doi.org/10.1016/s0002-9378(96)80003-2
14. Ambrose, S., Rhea, D. J., Istwan, N. B., Collins, A., & Stanziano, G. (2004). Clinical and economic outcomes of preterm labor management: inpatient vs outpatient. Journal of perinatology : official journal of the California Perinatal Association, 24(8), 515–519. https://doi.org/10.1038/sj.jp.7211139
15. Bekker, M. N., Koster, M. P. H., Keusters, W. R., Ganzevoort, W., de Haan-Jebbink, J. M., Deurloo, K. L., Seeber, L., van der Ham, D. P., Zuithoff, N. P. A., Frederix, G. W. J., van den Heuvel, J. F. M., & Franx, A. (2023). Home telemonitoring versus hospital care in complicated pregnancies in the Netherlands: a randomised, controlled non-inferiority trial (HoTeL). The Lancet. Digital health, 5(3), e116–e124. https://doi.org/10.1016/S2589-7500(22)00231-X
16. Dowswell, T., Middleton, P., & Weeks, A. (2009). Antenatal day care units versus hospital admission for women with complicated pregnancy. The Cochrane database of systematic reviews, 2009(4), CD001803. https://doi.org/10.1002/14651858.CD001803.pub2
17. Twaddle S. (1995). Day care for women with high-risk pregnancies. Nursing times, 91(4), 46–47.
18. Giannubilo, S. R., Bezzeccheri, V., Landi, B., Battistoni, G. I., Stortoni, P., Vitali, P., & Tranquilli, A. L. (2012). PP047. Outpatient management of pregnancy complicated by mild hypertensive disorders. Pregnancy hypertension, 2(3), 267. https://doi.org/10.1016/j.preghy.2012.04.158
19. Barton, J. R., Istwan, N. B., Rhea, D., Collins, A., & Stanziano, G. J. (2006). Cost-savings analysis of an outpatient management program for women with pregnancy-related hypertensive conditions. Disease management: DM, 9(4), 236–241. https://doi.org/10.1089/dis.2006.9.236
20. Dunlop, L., Umstad, M., McGrath, G., Reidy, K., & Brennecke, S. (2003). Cost-effectiveness and patient satisfaction with pregnancy day care for hypertensive disorders of pregnancy. The Australian & New Zealand journal of obstetrics & gynaecology, 43(3), 207–212. https://doi.org/10.1046/j.0004-8666.2003.00061.x
21. Cavassini, A. C., Lima, S. A., Calderon, I. M., & Rudge, M. V. (2012). Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil. Sao Paulo medical journal = Revista paulista de medicina, 130(1), 17–26. https://doi.org/10.1590/s1516-31802012000100004
22. Alalade, A. O., Khan, R., & Dawlatly, B. (2007). Day-case management of hyperemesis gravidarum: Feasibility and clinical efficacy. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 27(4), 363–364. https://doi.org/10.1080/01443610701327396
23. McCarthy, F. P., Murphy, A., Khashan, A. S., McElroy, B., Spillane, N., Marchocki, Z., Sarkar, R., & Higgins, J. R. (2014). Day care compared with inpatient management of nausea and vomiting of pregnancy: a randomized controlled trial. Obstetrics and gynecology, 124(4), 743–748. https://doi.org/10.1097/AOG.0000000000000449
24. Murphy, A., McCarthy, F. P., McElroy, B., Khashan, A. S., Spillane, N., Marchocki, Z., Sarkar, R. K., & Higgins, J. R. (2016). Day care versus inpatient management of nausea and vomiting of pregnancy: cost utility analysis of a randomised controlled trial. European journal of obstetrics, gynecology, and reproductive biology, 197, 78–82. https://doi.org/10.1016/j.ejogrb.2015.10.022
25. Heaman, M., & Gupton, A. (1998). Perceptions of bed rest by women with high-risk pregnancies: A comparison between home and hospital. Birth (Berkeley, Calif.), 25(4), 252–258. https://doi.org/10.1046/j.1523-536x.1998.00252.x
26. Turnbull, D. A., Wilkinson, C., Gerard, K., Shanahan, M., Ryan, P., Griffith, E. C., Kruzins, G., & Stamp, G. E. (2004). Clinical, psychosocial, and economic effects of antenatal day care for three medical complications of pregnancy: a randomised controlled trial of 395 women. Lancet (London, England), 363(9415), 1104–1109. https://doi.org/10.1016/S0140-6736(04)15893-5
27. Walker J. J. (1993). Day care obstetrics. British journal of hospital medicine, 50(5), 225–226.
28. Figà-Talamanca I. (1996). Maternal mortality and the problem of accessibility to obstetric care; the strategy of maternity waiting homes. Social science & medicine (1982), 42(10), 1381–1390. https://doi.org/10.1016/0277-9536(95)00286-3