Abstract
The provision of obstetric emergency care has long been complicated by an uncertain legal environment including ambiguity about restrictions relating to pregnancy termination. This uncertainty about legal constraints may result in clinical repercussions that could limit access to care for a broad spectrum of conditions, not just those that are explicitly prohibited. On June 24, 2022, the Supreme Court repealed the constitutional right to abortion, triggering a wave of restrictions across states, which further limits provision of pregnancy termination, sometimes even for potentially life-threatening situations. For example, about 1% of pregnancies are ectopic, and if not terminated promptly, fallopian rupture and life-threatening hemorrhage can occur. As a result, affected physicians are forced to wait for life-threatening conditions to occur before intervening in potentially life-threatening conditions to avoid running afoul of state restrictions. To begin exploring the potential impact of existing restrictions as well as recent state policy changes on maternal morbidity and mortality we have assembled a novel multidisciplinary team including clinicians and policy researchers from the Departments of Obstetrics and Gynecology and Emergency Medicine and as well as the Schaeffer Center for Health Policy and Economics led by Brian T. Nguyen, MD MSc (Obstetrics), Sarah Axeen, PhD, (Emergency Medicine/Schaeffer Center for Health Policy and Economics) and Sophie Terp, MD (Emergency Medicine).
The proposed study will characterize and define obstetric emergencies (Aim 1), use that definition to document variation in the management of, morbidity related to, and mortality resulting from treatment of obstetric emergencies (Aim 2), and to evaluate the federal regulatory response to sub-standard obstetric emergency care (Aim 3). Each aim will generate significant, innovative findings that will lead to publications and future extramural funding. Further, this collaboration will position USC to become a center of excellence for the study of the impact of health policy on reproductive health.