Patients with high-risk pregnancies and complicated deliveries have an increased risk of maternal postpartum readmissions

Sharvit, Merav; Rubinstein, T H; Ravid, Dorit; Shechter‐Maor, Gil; Fishman, Ami; Biron‐Shental, Tal

doi:10.1007/s00404-014-3255-z

Cited by 20 publications

(15 citation statements)

References 16 publications

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“…CSs are associated with more blood loss, more risk of bladder and ureteral injuries, postpartum infections, pulmonary embolisms, and more risks of neonatal respiratory complications (if performed before 39 weeks). [ 3 4 5 ] In addition, multiple repeat CSs can lead to increased risk of maternal morbidity and mortality because of abnormal placental adherence and cesarean hysterectomy, which increases with each subsequent CS. [ 6 7 ] Such complications are difficult to manage and can cause significant consequences and even maternal death.…”

Section: Introductionmentioning

confidence: 99%

Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section

Kiwan

Qahtani

2018

Ann Afr Med

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Objective:The purpose of this study is to compare the success rate of vaginal birth after cesarean (VBAC) in spontaneous and induced labor.Design:This is an 8-year retrospective comparative study.Setting:University hospital.Population:Five hundred and ninety-four women who had one previous lower segment cesarean delivery.Materials and Methods:This is a retrospective study of all women, who had lower segment cesarean section, admitted for trial of labor between April 2010 and November 2016. Five hundred and sixty-seven women who elected to have trial of labor after one previous cesarean were included in the study, of these 477 (84.13%) had spontaneous onset of labor (control group) and 90 (15.87%) had induction of labor (IOL) (study group). Two hundred and seventy-seven women had no previous vaginal delivery, and 297 had one previous vaginal delivery.Results:We compared the success rates of VBAC in women who had IOL with those who came with spontaneous labor. The rate of vaginal delivery after CS (VBAC) was 50.0% and 66.6% in the study and control groups, respectively. There was a significant increase in the rate of cesarean delivery due to fetal distress in the study group (P = 0.016). There were no cases of uterine rupture in the control group and one case in the study group. Patients who had spontaneous labor and at least one previous vaginal delivery have higher success rate of vaginal delivery.Conclusion:Women with one previous CS, who undergo IOL, have lower success rates of vaginal delivery compared with those who presented in spontaneous labor. They also have higher risk of CS delivery due to fetal distress. Previous normal vaginal delivery increases the success rate of VBAC.

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Section: Introductionmentioning

confidence: 99%

Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section

Kiwan

Qahtani

2018

Ann Afr Med

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“…Previous studies have identified a range of risk factors for readmission, including advanced age, socioeconomic status, chronic comorbidities, multiple gestation, cesarean delivery, and other highrisk pregnancy conditions. 1,4,5 Maternal race may represent a particularly important risk factor for postpartum readmissions and associated complications. Maternal race is a major risk factor adverse obstetric outcomes, and a number of previous analyses have addressed disparities in overall risk for severe morbidity and mortality.…”

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confidence: 99%

Maternal outcomes by race during postpartum readmissions

Aziz

Gyamfi-Bannerman

Siddiq

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Maternal race may be an important risk factor for postpartum readmissions and associated adverse outcomes. OBJECTIVE: To determine the association of race with serious complications during postpartum readmissions. STUDY DESIGN: This repeated cross-sectional analysis used the National (Nationwide) Inpatient Sample from the Healthcare Cost and Utilization Project from 2012 to 2014. Women ages 15e54 readmitted postpartum after a delivery hospitalization were identified by Centers for Disease Control and Prevention criteria. Race and ethnicity were characterized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific islander, Native American, other, and unknown. Overall risk for readmission by race was determined. Risk for severe maternal morbidity during readmissions by race was analyzed. Individual outcomes including pulmonary edema/acute heart failure and stroke also were analyzed by race. Log-linear regression models including demographics, hospital factors, and comorbid risk were used to analyze risk for severe maternal morbidity during postpartum readmissions. RESULTS: Of 11.3 million births, 207,730 (1.8%) women admitted postpartum from 2012 to 2014 were analyzed, including 96,670 white, 47,015 black, and 33,410 Hispanic women. Compared with non-Hispanic white women, non-Hispanic black women were at 80% greater risk of postpartum readmission (95% confidence interval, 79%e82%) whereas Hispanic women were at 11% lower risk of readmission (95% confidence interval, 10%e12%). In unadjusted analysis, compared with non-Hispanic white women, non-Hispanic black women admitted postpartum were at 27% greater risk of severe maternal morbidity (95% confidence interval, 24%e30%) whereas Hispanic women were at 10% lower risk (95% confidence interval, 7%e13%). In the adjusted model, non-Hispanic black women were at 16% greater risk for severe maternal morbidity during readmission than non-Hispanic white women (95% confidence interval, 10%e22%), whereas Hispanic women were at 7% lower risk (95% confidence interval, 1%e12%). Differences in severe maternal morbidity risk between other racial groups and non-Hispanic white women were not significant. In addition to overall morbidity, non-Hispanic black women were at significantly greater risk for eclampsia, acute respiratory distress syndrome, and renal failure than other racial groups (P<.05 all). Black women were at 126% greater risk for pulmonary edema/acute heart failure than white women (95% confidence interval, 117%e136%). CONCLUSION: Black women were more likely (1) to be readmitted postpartum, (2) to suffer severe maternal morbidity during readmission, and (3) to suffer life threatening complications such as pulmonary edema/ acute heart failure. At-risk women including black women with cardiovascular risk factors may benefit from short-term postpartum follow-up.

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“…In our cohort, postpartum maternal readmission with sepsis within 9 months of delivery occurred in 26 per 100,000 deliveries (95% CI [24][25][26][27][28][29]. Epidemiologic studies from the United States, United Kingdom, and the Netherlands estimated the rate of pregnancy-related sepsis to occur in 9 to 49 per 100,000 deliveries [11][12][13] ; however, these studies did not specifically investigate the postpartum period.…”

Section: Discussionmentioning

confidence: 99%

“…Pregnancy-related readmissions in the postpartum period is an increasing area of interest, but there is a gap in our knowledge on the role of sepsis in these readmissions. [25][26][27][28][29] We found that the majority of readmissions with maternal sepsis were late readmissions, but these readmissions remained associated with events occurring at the delivery hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Maternal Readmission with Sepsis

et al. 2019

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Objective Our primary objective was to identify risk factors for maternal readmission with sepsis. Our secondary objectives were to (1) assess diagnoses and infecting organisms at readmission and (2) compare early (<6 weeks) and late (6 weeks to 9 months postpartum) maternal readmission with sepsis. Study Design We identified our cohort using linked hospital discharge data and birth certificates for California deliveries from 2008 to 2011. Consistent with the 2016 sepsis classification, we defined sepsis as septicemia plus acute organ dysfunction. We compared women with early or late readmission with sepsis to women without readmission with sepsis. Results Among 1,880,264 women, 494 (0.03%) were readmitted with sepsis, 61% after 6 weeks. Risk factors for readmission with sepsis included preterm birth, hemorrhage, obesity, government-provided insurance, and primary cesarean. For both early and late sepsis readmissions, the most common diagnoses were urinary tract infection and pyelonephritis, and the most frequently identified infecting organism was gram-negative bacteria. Women with early compared with late readmission with sepsis shared similar obstetric characteristics. Conclusion Maternal risk factors for both early and late readmission with sepsis included demographic characteristics, cesarean, hemorrhage, and preterm birth. Risks for sepsis after delivery persist beyond the traditional postpartum period of 6 weeks.

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Patients with high-risk pregnancies and complicated deliveries have an increased risk of maternal postpartum readmissions

Abstract: The rate of patients with high-risk pregnancies and complicated deliveries is higher among postpartum maternal readmissions. These data might suggest more cautious postpartum care for those patients.

Cited by 20 publications

References 16 publications

Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section

Outcome of vaginal birth after cesarean section: A retrospective comparative analysis of spontaneous versus induced labor in women with one previous cesarean section

Maternal outcomes by race during postpartum readmissions

Risk Factors for Maternal Readmission with Sepsis

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