Severe maternal morbidity at delivery and postpartum readmission in the United States

Abstract

Background Little is known about the extent to which severe maternal morbidity (SMM) at delivery impacts early and late postpartum readmission. Objectives We examined readmission rates for women with and without SMM (and their 18 subtypes) at delivery and characterised the most common medical reasons for readmissions. Methods We conducted a retrospective cohort study utilising the 2016‐2017 Nationwide Readmissions Database among women giving births in the United States. Deliveries were classified according to the presence or absence of 18 SMM indicators defined by the Centers for Disease Control and Prevention using the International Classification of Diseases, Tenth Edition, Clinical Modification (ICD‐10‐CM) diagnosis and procedure codes. The primary outcome of this study was all‐cause early (≤7 day) and late (8 to 42 day) postpartum readmission. Survey‐weighted Poisson regression with robust error variance was used to generate adjusted risk ratios (RR) and 95% confidence intervals (CI) to investigate the association between SMM and early and late postpartum readmission. Additionally, we compared principal diagnoses codes during readmission hospitalisations among women with and without SMM at delivery. Results Of the 6 193 852 women examined, 4.9% (n = 4928) with any SMM and 1.4% (n = 83 995) with no SMM were readmitted within 42 days after delivery. After adjusting for obstetric co‐morbidities and sociodemographic factors, women with any SMM were 57% (RR 1.57, 95% CI 1.47, 1.67) more likely to have an early readmission and 69% (RR 1.69, 95% CI 1.57, 1.82) more likely to have a late readmission compared to women with no SMM at delivery. However, the risk was attenuated when excluding women with blood transfusion only. Women with and without SMM were readmitted predominantly for obstetric complications and infections. Conclusions Women with SMM at delivery were more likely to experience both early and late postpartum readmission, independent of their obstetrical co‐morbidity burden and sociodemographic factors.

Structural Racism and Maternal Morbidity among Black Women

“…( The non-Hispanic Black terminology is used to be consistent with Center for Disease Control and vital statistics reporting .). Non-Hispanic Black ( referred to hereafter as Black ) women also have higher rates of emergency department visits and hospital readmissions in the first 6 weeks after birth, also indicators of maternal morbidity, than Whites (Johnson et al, 2019; Matas et al, 2021; Wang et al, 2020). A recent systematic review reported that Black women had an adjusted risk ratio (RR) for SMM of 1.2–5 compared with Whites (Wang et al, 2020).…”

Severe maternal morbidity and risk of cardiovascular disease: Recent advances

“…For each maternal death, it is estimated that there are 20 or more cases of severe maternal morbidity [17]. The incidence of severe maternal morbidity is approximately 1.6% in North America, 1.2% in Australia, and 0.7% in the Netherlands [16,[18][19][20]. Variation in incidence is partly due to differences in the definition and measurement of severe maternal morbidity.…”

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

“…Hypertensive disorders in pregnancy (HDP) are one of the most common causes for obstetric-related readmissions. 1 Previous studies have published postpartum readmission rates due to HDP ranging from 0.4% to 9.3%. 2 , 3 , 4 , 5 , 6 Severe maternal morbidities related to postpartum hypertension and preeclampsia include stroke, eclampsia, and death.…”

“… 2 , 3 , 4 , 5 , 6 Severe maternal morbidities related to postpartum hypertension and preeclampsia include stroke, eclampsia, and death. 1 , 7 Between 2014-2017, HDP comprised 6.6% of pregnancy-related deaths. 8 These serious risks are why prompt and thorough evaluations are warranted for patients who exhibit any signs or symptoms of HDP in pregnancy and postpartum.…”