Although there are nearly 4 million deliveries in the United States each year, too little is known about unintended consequences of childbirth, especially as related to the method of delivery. The present study is the first US population-based study to specify the risk of maternal postpartum readmission to the hospital in relation to method of delivery and was performed in a large group of primiparous women not known to have any high-risk medical condition. The retrospective study included more than a quarter million (256,795) women who delivered live singleton infants in short-stay hospitals in Washington State during the years 1987–1996.The 3149 women rehospitalized within 2 months after delivery represented 1.2 percent of the study population. Uterine infection and postpartum bleeding were the most common reasons, followed by gallbladder disease, genitourinary complications, breast infection, wounds from obstetrical surgery, mental health considerations, and cardiopulmonary complications. Multivariate analysis adjusting for maternal age showed that women having a cesarean delivery were nearly twice as likely to be readmitted than those having spontaneous vaginal deliveries; the relative risk (RR) was 1.8. Assisted vaginal delivery also increased the risk (RR, 1.3). The hospital stay was longer after operative delivery than spontaneous vaginal delivery. Uterine infection, gallbladder disease, and genitourinary disorders were among the prominent indications for readmission in women having cesarean delivery. Surgical wound infection was a very prominent occurrence in this group. Postpartum bleeding was a factor in women delivering vaginally, whether spontaneously or with assistance. The investigators conclude that high priority should be given to developing strategies for preventing and controlling peripartum infection in women who undergo cesarean or assisted vaginal delivery.JAMA 2000;283:2411–2416
展开▼
