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Postpartum hemorrhage and risk for postpartum readmission
| Content Provider | Scilit |
|---|---|
| Author | D’Alton, Mary E. Fein, Arielle Wen, Timothy Wright, Jason D. Goffman, Dena Attenello, Frank J. Mack, William J. Friedman, Alexander M. |
| Copyright Year | 2019 |
| Abstract | Objective: This study had two objectives: (i) to evaluate risk factors for postpartum readmission for a primary diagnosis of postpartum hemorrhage (PPH) among all women, and (ii) to determine risk for postpartum readmission specifically among women with PPH during their delivery hospitalization. Methods: The Healthcare Cost and Utilization Project’s Nationwide Readmissions Database for 2010 to 2014 was used to evaluate risk for postpartum readmission for PPH within 60 days of discharge from a delivery hospitalization. Obstetric, medical, demographic, and hospital factors including PPH during the index delivery were analyzed. Sixty-day postpartum readmission for PPH was the primary outcome. Both unadjusted and adjusted analyses were performed. In adjusted models, risk was characterized as adjusted risk ratios (aRR) with 95% confidence intervals (CI). As a secondary outcome to further characterize how PPH at delivery was associated with readmission likelihood, risk for all-cause readmission was evaluated among women with this diagnosis during their delivery. Results: Of 15 701 150 delivery hospitalizations, 10 618 women were readmitted postpartum for a primary indication of postpartum hemorrhage. Eighty-two% of readmissions occurred ≤ 20 days after discharge. In the adjusted model for readmission for PPH, PPH during the delivery hospitalization was associated with aRR of 5.26 (95% CI 4.94, 5.59) for hemorrhage alone, aRR of 14.28 (95% CI 13.06, 15.60) for hemorrhage requiring transfusion, and aRR of 12.40 for PPH with disseminated intravascular coagulation (DIC) requiring transfusion (95% CI 9.56–16.08) compared to no PPH. For the secondary analysis evaluating all-cause readmission, PPH during delivery was associated with aRR of 1.47 for PPH alone (95% CI 1.44–1.51), aRR of 2.43 for PPH requiring transfusion (95% CI 2.34–2.52), and aRR of 2.77 for PPH with DIC requiring transfusion (95% CI 2.54–3.03) compared to no PPH. Conclusion: PPH at delivery is a significant risk factor for subsequent readmission both for PPH and for all causes. For women who undergo large hemorrhage during delivery, shorter interval postpartum follow up may be indicated. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7135873/pdf |
| Ending Page | 194 |
| Page Count | 8 |
| Starting Page | 187 |
| ISSN | 14767058 |
| e-ISSN | 14764954 |
| DOI | 10.1080/14767058.2019.1601697 |
| Journal | The Journal of Maternal-Fetal & Neonatal Medicine |
| Issue Number | 2 |
| Volume Number | 34 |
| Language | English |
| Publisher | Informa UK Limited |
| Publisher Date | 2021-01-17 |
| Access Restriction | Open |
| Subject Keyword | Womens Studies Severe Morbidity Hemorrhage Maternal Outcomes Maternal Safety Obstetric Readmissions |
| Content Type | Text |
| Resource Type | Article |
| Subject | Pediatrics, Perinatology and Child Health Obstetrics and Gynecology |
