Association between method of delivery and maternal rehospitalization.
BACKGROUND
Despite nearly 4 million deliveries in the United States each year, minimal information exists on unintended health consequences following childbirth, particularly in relation to delivery method.


OBJECTIVE
To assess the risk for maternal rehospitalization associated with cesarean or assisted vaginal delivery compared with spontaneous vaginal delivery.


METHODS
Retrospective cohort study of data from the Washington State Birth Events Record Database for 1987 through November 1, 1996.


METHODS
All primiparous women without selected chronic medical conditions who delivered live singleton infants in nonfederal short-stay hospitals in Washington State (N =256,795).


METHODS
Relative risks (RRs) of rehospitalization within 60 days of cesarean or assisted vaginal vs spontaneous vaginal deliveries.


RESULTS
A total of 3149 women (1.2%) were rehospitalized within 60 days of delivery. In logistic regression analyses adjusting for maternal age, rehospitalization was found to be more likely among women with cesarean delivery (RR, 1.8; 95% confidence interval [CI], 1.6-1.9) or assisted vaginal delivery (RR, 1.3; 95% CI, 1.2-1.4) than among women with spontaneous vaginal delivery. Cesarean delivery was associated with significantly increased risks of rehospitalization for uterine infection, obstetrical surgical wound complications, and cardiopulmonary and thromboembolic conditions. Among women with assisted vaginal delivery, significant increased risks were seen for rehospitalization with postpartum hemorrhage, obstetrical surgical wound complications, and pelvic injury.


CONCLUSIONS
Women with cesarean and assisted vaginal deliveries were at increased risk for rehospitalization, particularly with infectious morbidities. Effective strategies for preventing and controlling peripartum infection should be an obstetrical priority.
Lydon-Rochelle
M
M
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195-7262, USA. minot@u.washington.edu
Holt
V L
VL
Martin
D P
DP
Easterling
T R
TR
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D014861:Washington