Am J Perinatol 2021; 38(S 01): e137-e145
DOI: 10.1055/s-0040-1708803
Original Article

Maternal Health after Stillbirth: Postpartum Hospital Readmission in California

Elizabeth Wall-Wieler
1  Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Alexander J. Butwick
2  Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
,
3  Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Deirdre J. Lyell
3  Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Anna I. Girsen
3  Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Yasser Y. El-Sayed
3  Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
,
Suzan L. Carmichael
4  Department of Pediatrics and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
› Author Affiliations
Funding This study received funding from Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine; Department of Obstetrics and Gynecology, Stanford University School of Medicine; U.S. Department of Health and Human Services, National Institutes of Health; Eunice Kennedy Shriver National Institute of Child Health and Human Development HD095034; and U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Nursing Research NR017020.

Abstract

Objective The aim of this study is to assess whether the risk of postpartum readmission within 6 weeks of giving birth differs for women who had stillbirths compared with live births.

Study Design Using data from the Office of Statewide Health Planning and Development in California, we performed a population-based cohort study of 7,398,640 births between 1999 and 2011. We identified diagnoses and procedures associated with the first postpartum hospital readmission that occurred within 6 weeks after giving birth. We used log-binomial models to estimate relative risk (RR) of postpartum readmission for women who had stillbirth compared with live birth deliveries, adjusting for maternal demographic, prepregnancy, pregnancy, and delivery characteristics.

Results The rate of postpartum readmission was higher among women who had stillbirths compared with women who had live births (206 and 96 per 10,000 births, respectively). After adjusting for maternal demographic and medical characteristics, the risk of postpartum readmission for women who had stillbirths was nearly 1.5 times greater (adjusted RR = 1.47, 95% confidence interval: 1.35–1.60) compared with live births. Among women with stillbirths, the most common indications at readmission were uterine infection or pelvic inflammatory disease, psychiatric conditions, hypertensive disorder, and urinary tract infection.

Conclusion Based on our findings, women who have stillbirths are at higher risk of postpartum readmissions within 6 weeks of giving birth than women who have live births. Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications.

Key Points

  • Women who have stillbirths are at nearly 1.5 times greater risk of postpartum readmission than women who have live births.

  • Uterine infections and pelvic inflammatory disease, and psychiatric conditions are the most common reasons for readmission among women who had a stillbirth.

  • Women who have stillbirths may benefit from additional monitoring and counseling after hospital discharge for potential postpartum medical and psychiatric complications.

Supplementary Material



Publication History

Received: 04 December 2019

Accepted: 13 February 2020

Publication Date:
04 May 2020 (online)

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