Characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor or preterm premature rupture of membranes

Jameaka L. Hamilton, Department of Obstetrics and Gynecology at The Ohio State University, Columbus, OH (Hamilton and Costantine).
Paula L. McGee, The George Washington University Biostatistics Center, Washington, DC (Mcgee and Clifton).
George R. Saade, University of Texas Medical Branch, Galveston, TX (Saade and Salazar).
Rebecca G. Clifton, The George Washington University Biostatistics Center, Washington, DC (Mcgee and Clifton).
Michael W. Varner, University of Utah Health Sciences Center, Salt Lake City, UT (Varner).
Alan T. Tita, University of Alabama at Birmingham, Birmingham, AB (Tita).
Monica Longo, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (Longo).
Edward F. Bell, University of Iowa, Iowa City, IA (Bell).
Barbara J. Stoll, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA (Stoll).
Donna Allard, Brown University, Providence, RI (Allard and Rouse).
Ashley Salazar, University of Texas Medical Branch, Galveston, TX (Saade and Salazar).
John M. Thorp, University of North Carolina at Chapel Hill, Chapel Hill, NC (Thorp).
Uma M. Reddy, Columbia University, New York, NY (Reddy).
Maged M. Costantine, Department of Obstetrics and Gynecology at The Ohio State University, Columbus, OH (Hamilton and Costantine).
Emily S. Miller, Northwestern University, Chicago, IL (Miller).
Dwight J. Rouse, Brown University, Providence, RI (Allard and Rouse).
Hyagriv N. Simhan, University of Pittsburgh, Pittsburgh, PA (Simhan).
Jennifer L. Bailit, Case Western Reserve University, Cleveland, OH (Bailit).
Lorraine Dugoff, University of Pennsylvania, Philadelphia, PA (Dugoff).
George A. Macones, University of Texas at Austin, Austin, TX (Macones).
Baha M. Sibai, University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, TX (Sibai).

Document Type

Journal Article

Publication Date

11-1-2025

Journal

AJOG global reports

Volume

5

Issue

4

DOI

10.1016/j.xagr.2025.100565

Keywords

adverse pregnancy outcomes; obstetric triage utilization; pregnancy; prenatal care

Abstract

BACKGROUND: Hospital-based obstetrical triage units frequently serve as an extension to outpatient care. Evaluation of the burden of preterm birth (PTB) typically focuses on the delivery and neonatal periods, while antepartum health care utilization related to risk of PTB is seldom reported. OBJECTIVE: To identify the characteristics and outcomes associated with multiple triage visits among patients with suspected preterm labor (PTL) or preterm premature rupture of membranes (pPROM). STUDY DESIGN: Secondary analysis of a retrospective cohort study of all triage visits from 20 0/7 through 34 6/7 weeks gestation on randomly selected dates in 2019 at 34 hospitals across the US. Those in whom the reason for the visit was suspected PTL or pPROM and who were subsequently discharged were eligible for this analysis. Patients with ≥3 triage visits were compared with those who had <3 visits in the index pregnancy visits. Data were abstracted by certified research personnel using predefined criteria. The primary outcome was a composite of severe neonatal morbidity or mortality before 120 days. Secondary outcomes included PTB (<37 weeks gestation), a composite of respiratory neonatal morbidities, and maternal outcomes. Multivariable logistic regression analyses were used for the maternal outcomes, and generalized linear and logistic models were used for the neonatal outcomes to account for the correlation among twins. RESULTS: A total of 1764 mother/newborn dyads were included. Patients with more frequent triage visits (≥3) were more likely to self-identify as Black, be younger, not married/living with a partner, unemployed, have government-assisted insurance, or have less than a college degree compared to those individuals with less frequent triage visits (P<.05). Additionally, individuals in the more frequent triage visits group were more likely to be multiparous, have obesity, and pre-existing medical conditions, including kidney or liver disease requiring treatment (P<.05). There were no significant differences between groups for the primary composite neonatal outcome (1.6% in the more frequent group vs 2.4% in the less frequent group, adjusted odds ratios [aOR] 0.69, 95% CI 0.35-1.39) or secondary neonatal outcomes including PTB less than 37 weeks gestation (25.2% vs 23.2%, aOR 0.94, 95% CI 0.68-1.30), composite of respiratory morbidity (11.8% vs 11.0%, aOR 1.01, 95% CI 0.71-1.43), SGA (10.5% vs 10.6%, aOR 0.92, 95% CI 0.66-1.29), or birthweight (3056±639 g vs 3048±678 g, LS mean 27, 95% CI -27, 82). Similarly, there were also no statistically significant differences between groups for the secondary maternal outcomes including composite of severe maternal morbidity (8.1% vs 8.7%, aOR 1.00, 95% CI 0.69-1.44), composite of maternal infection (5.8% vs 5.1%, aOR 1.11, 95% CI 0.72-1.73), or delivery via cesarean section (31.2% vs 35.2%, aOR 0.86, 95% CI 0.69-1.07). CONCLUSION: In this multisite registry of triage visits with rigorous ascertainment and data collection, multiple visits (≥3) for suspected PTL or pPROM were not associated with differences in maternal or neonatal outcomes.

Department

Epidemiology

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