Postpartum hemorrhage and risk for postpartum readmission. (17th January 2021)

• Record Type: Journal Article
• Authors: Fein, Arielle; Wen, Timothy; Wright, Jason D.; Goffman, Dena; D'Alton, Mary E.; Attenello, Frank J.; Mack, William J.; Friedman, Alexander M.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 34:Number 2(2021)
• Page Start: 187
• Page End: 194
• Publication Date: 2021-01-17
• Subjects: Severe morbidity -- hemorrhage -- obstetric readmissions -- maternal outcomes -- maternal safety; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2019.1601697
• Languages: English
• ISSNs: 1476-7058

Abstract

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, the 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, the risk for all-cause readmission was evaluated among women with this diagnosis during their delivery. Results: Of the 15, 701, 150 delivery hospitalizations, 10, 618 women were readmitted postpartum for a primary indication of postpartum hemorrhage. Eighty-two percent 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.