Via Research Recognition Day Program VCOM-Carolinas 2025

Clinical Educational Research

Impact of Prenatal Care on Management of Vaginal Bleeding During Pregnancy and Disparities in Underrepresented Minority Populations Cesar Prugue, OMS III 1 , Camden Pereira, OMS III 1 , David Redden, PhD 2 , Kristine Lombardozzi, MD 1 , Steven Lewis, MD 1

1. Edward Via College of Osteopathic Medicine, Spartanburg, SC 2. Edward Via College of Osteopathic Medicine, Auburn, AL

Introduction

Results

Discussion

Descriptive statistics were calculated for continuous (mean, standard deviation) and categorical variables (proportions). Associations with outpatient follow-up within 14 days were tested using Pearson Chi-square for categorical variables and logistic regression for continuous predictors. Analyses were conducted in SAS 9.4 with a Type I error rate of 0.05.

References 1. Hansen DE, Goldfarb SS, Mercouffer A, et al. Racial inequities in ED wait times for pregnancy-related concerns. Women’s Health . 2022;18. 2. Nekkanti AC, Hazra D, George RM, et al. Pregnancy-related emergencies: profile and outcome. J Family Med Prim Care . 2020;9(9):4618-4622. 3. Nazzal EM, Waller AE, Meyer ML, et al. Pregnancy and ED utilization in North Carolina, 2016-2021. AJPM Focus . 2023;2(4):100142. 4. Trostian B, Curtis K, McCloughen A, et al. Bleeding in early pregnancy presenting to the ED: an integrative review. Australas Emerg Care . 2022;25(1):55-83. 5. Trostian B, McCloughen A, Fethney J, Curtis K. Presentation trends and outcomes for early pregnancy bleeding in the ED: A 10-year study. Aust N Z J Obstet Gynaecol. 2023;63(6):803-810. doi: 10.1111/ajo.13733. 6. Sabloak T, Yee LM, Feinglass J. Antepartum ED use and maternal and neonatal outcomes. Womens Health Rep. 2023;4(1):562-570. doi: 10.1089/whr.2023.0072. 7. Benson LS, Magnusson SL, Gray KE, et al. Early pregnancy loss in the ED, 2006-2016. JACEP Open. 2021;2(6):e12549. doi: 10.1002/emp2.12549. We thank our mentors and physicians for their expertise and guidance throughout this study This study was approved by the Spartanburg Regional Healthcare System Institutional Review Board (IRB), protocol #2253839, on October 29, 2024. The study was reviewed under expedited review category #5 and determined to be minimal risk. Acknowledgements Conclusions ● Established prenatal care significantly improves outpatient follow up within 14 days ● Additional statistical analysis will be performed to compare associations between URM status and ED revisits, as well as ED consultations and 14 day follow-up ● Future Research: ○ Continue investigating obstacles to establishing prenatal care, especially in underserved populations ○ Explore barriers to follow-up for patients lacking prenatal care ● Current literature suggests URM status heavily influences care processes, therefore further analysis controlling for this is needed to observe whether or not prenatal care is a true mitigating factor ● Follow up in outpatient settings, as opposed to the ED has been shown to result in better maternal and fetal outcomes ● Findings highlight the importance of improving follow-up protocols for patients who present for bleeding during pregnancy. ● Summary of study : Patients with established prenatal care had 2.4 times the odds of receiving outpatient follow-up within 14 days of their initial vaginal bleeding complaint as compared to those without prenatal care (p = .0177). ● Preliminary data found no significant difference between age, race, insurance, or ED consultations and outpatient follow-up.

Vaginal bleeding during pregnancy is a common reason for emergency department (ED) visits, affecting approximately 1 in 4 pregnancies. Frequent ED utilization during pregnancy has been associated with adverse birth outcomes, particularly among underrepresented minority (URM) and publicly insured populations. These disparities highlight the importance of understanding how prenatal care influences clinical management and outcomes for pregnant patients. Research Goal : To examine the impact of prenatal care on care processes and outcomes for pregnant patients presenting with vaginal bleeding, with a focus on disparities among underrepresented minority populations. Hypotheses : 1.Care processes for URM patients will significantly differ based on prenatal care status. 2.Among patients with prenatal care, care processes will differ between URM and non-minority patients.

Methods

Figure 1. Forest Plot Demonstrating Odds Ratios at 95% Confidence Interval.

● Design: Cross-sectional retrospective study (Jan 2019 – Dec 2019). ● Setting: Spartanburg Regional Healthcare System EDs and OB-ED. ● Population: Pregnant patients (ages 20-44) with chief complaint of vaginal bleeding.

Figure 2. Examination of Associations between Patient Characteristics and Outpatient Follow-up within 14 days.

2025 Research Recognition Day

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