Despite the fact that about one million women experience miscarriages a year, there is little studies on complications related to pregnancy loss in the first trimester when most miscarriage occurs. The need to study this stage is urgently, the propublica experts said, given the prohibitions of the abortion of the state violations of the mother’s health care.
Although most early miscarriages are resolved without complications, patients with severe bleeding can hemorrhage if they do not receive appropriate treatment – which includes a procedure called enlargement and ceretage, or D&C, which is now confused in the legislation that prohibits abortion. As the women retells that left to lose a dangerous amount of blood, and propublica Told about the story of the mother who died in Houston’s hospital, seeking a miscarriageJournalists were looking for a way to get a broader understanding of what was happening in the state.
We consulted with dozens of researchers and clinicians to develop our methodology and understand how to look at the results of early miscarriage in the ambulance department.
Our latest analysis of the Texas Hospital found that after the state had abortted in August 2022, in August 2022, The amount of blood transfusions while visiting an ambulance For miscarriage, the first trimester increased by 54%.
The number of visitors during the miscarriage of the first trimester also increased by 25%that a sign that women can return to the hospital in the worst condition after sending home, propublica reported more than a dozen experts.
Experts say that a spike is an alarming indicator of care.
The most effective way to prevent severe blood loss during miscarriages, according to experts, is the D&C, which uses absorption to remove the remaining tissues, allowing the uterus to close. The procedure is also used to stop pregnancy.
Dr. Elliott Meng, an expert on the mother’s hemorrhage and the former medical director for joint quality of the mother in California, said the increase in transfusion suggested that the doctors who work under the ban on abortion post these interventions for the production of patients for longer – “while they are really bleeding.”
These findings add to the growing body propublica, which indicate that the mothers’s results have deteriorated after the ban on the abortion of the state. In February, we published analysis of hospitalization of pregnancy loss second trimesters The sepsis speed grew by more than 50% after the state banned abortion. This study was focused only on a stationary stay in Texas hospitals. However, many of the doctors and researchers we talked to us told us that this attention would be restricted to what we could say about the miscarriage earlier during pregnancy; Most people who experience pregnancy complications in the first trimester are likely to be seen in a shorter visit to the ambulance and not in a stationary stay.
This methodology teaches the steps we have taken to study the results of early miscarriage in the ambulance department to help experts and interested readers understand our approach and its restrictions.
Detection of emergency visits of the first trimester
We have purchased seven years of extracts for stationary and outpatient meetings in hospitals and outpatient surgical centers from the Texas Department of Health. These records contain certain data for visits, with the meeting information, including recorded diagnoses and procedures, as well as some demographic information of the patient and billing data.
We restricted our analysis visits with diagnosed pregnancy loss on both inpatient and outpatient sets. We adhered to the methodology that the motherhood researchers have used for many years to detect “abortion results” – cases of pregnancy loss in less than 20 weeks, which include diagnoses, such as ectopic pregnancy and miscarriage. Usually, researchers have identified these cases to exclude them from the metric, evaluating complications in childbirth. In contrast, we focused our analysis only at these meetings with a diagnosis of pregnancy loss. Medical experts suggested that it was possible that at home to manage abortions; Because the abortion that has been managing the medicine on its own will have a spontaneous miscarriage, we cannot differentiate these patients in our data.
We also limit our analysis either visits to the ambulance department, or with the help of a stationary stay in the ambulance department. The outpatient data of the state also include meetings for outpatient procedures and data for outpatient surgical centers that we exclude to focus on new hospital aid. Ultimately, our analysis was focused on 35,500 visits to the first trimester per year, which were received in the hospital through an ambulance department, except for a small number (about 1400 per year) of a stationary stay, which did not start in the trauma.
To limit our pregnancy loss analysis in the first trimester, we sought a diagnosis code indicating a pregnancy. In cases where the long hospitalization had several pregnancy codes recorded during the stay, we took the last one. We turned off any line that had a pregnancy code for 13 weeks or more, which means the start of the second trimester. The vast majority – 78% – visits to the ambulance for the loss of pregnancy had a code that indicates an unknown week of pregnancy or not at all diagnosing pregnancy. We included these visits in the first trimester category. The clippers told us that a pregnant patient who comes to the ambulance department in his first trimester, is less likely that the appointment of the doctor sets pregnancy. Because the loss of pregnancy in the second or third trimester is more serious, and because it is easier to set the pregnancy period, which further, the doctor of the ambulance is likely to be able to set pregnancy during the treatment in these cases.
We then filtered our visits list to those where the patient was female and between the ages of 10 and 54 to turn off the lines with potential mistakes. This deleted 2692 visits, or 1.1% of all visits we have identified.
The number of hospitalization of the first trimester in the ambulance department was relatively stable to COVID-19. In 2022, the first full year after the state passed a six -week ban on abortion, the number of meetings jumped by 11%. And in 2023, a year after the state criminally criminned, they increased again, increasing by 25% of the previous management level.
Although we could determine the increase in visits, we were unable to identify patients through visits, which means that we cannot say how many of these visits are the same person who returns to the ambulance several times for the same loss of pregnancy. In Texas there is an increase in living births after the state banned abortion 2.7% in 2022, compared to the average to communication and slightly decreased in 2023. But it is an increase in childbirth and expansion, pregnancy does not explain the speeds of changes in emergency visits, which is far superior to it.
The clippers also told us that the threshold for the diagnosis of pregnancy loss increased after the state banned abortion. To evaluate how many relevant visits, our analysis can leave and do we have more visits after changing the policy at the hospital, we sought visits without a pregnancy loss code, but diagnosed with “abortion” or “early pregnancy”, which indicates the uterine spasm or blood flow. Because clinicians have told us that these diagnoses could vary from light, to significant bleeding, and since bleeding during pregnancy is common and does not always indicate a miscarriage that goes in the process, we did not include these visits to our main analysis. However, we also determined the increase in visits by 23% with these codes – from the average level of 70 936 to COVID to 87 431 in 2023.
Detection of transfusions
Next, we determined a visit to pregnancy losses with transfusion, which usually indicates that there was a dangerous blood loss.
For our inpatient data set where the procedures were performed during hospitalization determined by centers for control and prevention. AcBulic data set that uses modern procedural codes has only one code – 36430 – for blood transfusions.
To COVID-19, average was 840 first visits for pregnancy loss in the first trimester, on average with blood transfusions. In 2022, the first full year after the state adopted the first ban on abortion, the transfusions increased to 1.076-felt by 28% compared to previous years. By 2023, the first full year after the abortion was criminally criminally, this number increased to 1290-counting by 54% compared to the previous ones. This is another 450 visits with blood transfusion in 2023 than average.
Even as the number of visits increases the number of visits with transfusions increased, from 2.5% in previous years to 2.8% in 2022 and 3% in 2023, changing that the transfusion increase could not be explained only by the increase in meetings.
Experts who considered the proopublica data were asked whether the transfusion increase was due to more women who have complications of ectopic or painting pregnancy, a rare non -viable pregnancy, in which blood transfusion is much higher than for spontaneous miscarriage. The data did not tolerate this. When we excluded visiting with ectopic pregnancy diagnoses, the increase in pregnancy transfusions was even higher – by 2023 it increased by 61%.
To understand whether there was an increase in the number of transfusions in other mother’s visits over the same period of time, we also considered blood transfusions in delivery events using a federal methodology to detect birth complications. At birth, the number of transfusions increased by 6.7% in 2022 and 9.9% in 2023 compared to the average in average, but less than the increase in hospitalization of pregnancy loss in the first trimester.
Sophie Chu included in the data report.
