Rehospitalization Rate Analyzed for Cesarean and Assisted Vaginal Deliveries

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An article in this week's Journal of the American Medical Association finds that, among the women studied, rehospitalization following cesarean delivery was almost twice as common as rehospitalization following vaginal delivery. Rehospitalization was also more common following assisted vaginal delivery (forceps or vacuum extraction).

Using data from Washington State from 1987 through 1996, the study assessed the risk for maternal rehospitalization associated with cesarean or assisted vaginal delivery (compared with spontaneous vaginal delivery) within 2 months of giving birth. Although only 1.2% (3,149) of all study subjects required rehospitalization, the authors found an 80% increase in postpartum rehospitalization risk among women with cesarean delivery, and a 30% increase in risk for those with assisted vaginal delivery. The study excluded women that suffered from certain chronic medical conditions.

The reasons for rehospitalization were uterine infection (27%), postpartum hemorrhage (21.6%), gallbladder disease (18.8%), genitourinary complications (11.7%), breast infections (10.9%), obstetrical surgical wounds (8.2%), mental health (6.2%), cardiopulmonary complications (6.1%), thromboembolic complications (3.7%), pelvic injury (3.1%), and appendicitis (2.9%). The authors state, "Our most notable result was a 30-fold risk associated with obstetrical surgical wound infection; however, the rate of rehospitalization for wound infection among women with cesarean delivery was still quite low (4/1000 cesarean procedures)."

Recommendations to improve women's postpartum health include increasing the availability of trained social support to help women while in labor, expanding midwives' role, using an epidural when labor pain management is necessary, and requiring second opinions on the necessity of cesarean delivery. The authors comment, "In addition to marking serious postpartum morbidity, maternal rehospitalization carries substantial consequences ... including high economic costs, the disruption of early parenting, and increased family burden. … Our most important finding, that women with cesarean and assisted vaginal delivery were at increased risk for rehospitalization with infectious morbidities, suggest that even more rigorous attention to effective peripartum infection prevention and control strategies should be an obstetrical care priority."

Lydon-Rochelle M, et al. 2000. Association between method of delivery and maternal rehospitalization. Journal of the American Medical Association 283(18):2411-2416. http://jama.ama-assn.org

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MCH Alert. 2001. Arlington, VA: National Center for Education in Maternal and Child Health. http://www.ncemch.org/alert.