title: Discharge against medical advice in an obstetric unit.
abstract: Obstetricians have increasingly petitioned courts for orders sanctioning treatment refused by pregnant patients. To speculate on the potential role of forced detention, we reviewed the clinical records of 39 obstetric patients who were discharged against medical advice (AMA) with several diagnoses: preterm labor (27), medical complications of pregnancy (9) and trauma (3). These patients were matched for chronologic age, gestational age and clinical examination at the time of admission and compared to a group of compliant patients who accepted and followed the treatment plan for hospitalization. No perinatal morbidity and/or mortality or other adverse outcome could be documented in the AMA group despite their refusal to continue undergoing admission and therapy. No difference could be demonstrated between the AMA group and the compliant group for obstetric complications, gestational age at delivery, newborn weight and percentage of appropriate-weight-for-gestational-age infants. These data suggest that failure to comply with major obstetric recommendations and hospitalization in these clinical settings might not adversely influence perinatal outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Tripler Army Medical Center, Honolulu, Hawaii.
authors.forename: G S
authors.initials: GS
authors.lastname: Letterie
authors.forename: G R
authors.initials: GR
authors.lastname: Markenson
authors.forename: M M
authors.initials: MM
authors.lastname: Markenson
mesh_terms: D005260:Female; D006801:Humans; D033222:Judicial Role; D010349:Patient Compliance; D010351:Patient Discharge; D011247:Pregnancy; D011256:Pregnancy Outcome; D037841:Pregnant People; D018570:Risk Assessment; D016312:Treatment Refusal