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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
,
Ronald S. Gibbs 
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.
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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.

Keywords

stillbirth - postpartum readmission - population health - maternal health

Supplementary Material



Publication History

Received: 04 December 2019

Accepted: 13 February 2020

Article published online:
04 May 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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  • References

  • 1 MacDorman MF, Gregory EC. Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 2015; 64 (08) 1-24
    Google Scholar
  • 2 Wall-Wieler E, Carmichael SL, Gibbs RS. et al. Severe maternal morbidity among stillbirth and live birth deliveries in California. Obstet Gynecol 2019; 134 (02) 310-317
    CrossrefPubMedGoogle Scholar
  • 3 Burden C, Bradley S, Storey C. et al. From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth 2016; 16 (01) 9
    CrossrefPubMedGoogle Scholar
  • 4 Hogue CJR, Parker CB, Willinger M. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network Writing Group. The association of stillbirth with depressive symptoms 6-36 months post-delivery. Paediatr Perinat Epidemiol 2015; 29 (02) 131-143
    CrossrefPubMedGoogle Scholar
  • 5 Gold KJ, Mozurkewich EL, Puder KS, Treadwell MC. Maternal complications associated with stillbirth delivery: a cross-sectional analysis. J Obstet Gynaecol 2016; 36 (02) 208-212
    CrossrefPubMedGoogle Scholar
  • 6 Friedman AM, Wright JD, Ananth CV, Siddiq Z, D'Alton ME, Bateman BT. Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations. Am J Obstet Gynecol 2016; 215 (05) 640.e1-640.e8
    CrossrefPubMedGoogle Scholar
  • 7 MacDorman MF, Reddy UM, Silver RM. Trends in stillbirth by gestational age in the United States, 2006-2012. Obstet Gynecol 2015; 126 (06) 1146-1150
    CrossrefPubMedGoogle Scholar
  • 8 Kilpatrick SJ, Abreo A, Gould J, Greene N, Main EK. Confirmed severe maternal morbidity is associated with high rate of preterm delivery. Am J Obstet Gynecol 2016; 215 (02) 233.e1-233.e7
    CrossrefPubMedGoogle Scholar
  • 9 Fretts R. Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention. Clin Obstet Gynecol 2010; 53 (03) 588-596
    CrossrefPubMedGoogle Scholar
  • 10 Warland J, Mitchell EA. A triple risk model for unexplained late stillbirth. BMC Pregnancy Childbirth 2014; 14 (01) 142
    CrossrefPubMedGoogle Scholar
  • 11 Willinger M, Ko CW, Reddy UM. Racial disparities in stillbirth risk across gestation in the United States. Am J Obstet Gynecol 2009; 201 (05) 469.e1-469.e8
    CrossrefPubMedGoogle Scholar
  • 12 Yao R, Ananth CV, Park BY, Pereira L, Plante LA. ; Perinatal Research Consortium. Obesity and the risk of stillbirth: a population-based cohort study. Am J Obstet Gynecol 2014; 210 (05) 457.e1-457.e9
    CrossrefPubMedGoogle Scholar
  • 13 Bodnar LM, Parks WT, Perkins K. et al. Maternal prepregnancy obesity and cause-specific stillbirth. Am J Clin Nutr 2015; 102 (04) 858-864
    CrossrefPubMedGoogle Scholar
  • 14 Hogue CJR, Parker CB, Willinger M. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Stillbirth Collaborative Research Network Writing Group. A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans. Am J Epidemiol 2013; 177 (08) 755-767
    CrossrefPubMedGoogle Scholar
  • 15 Aseltine Jr RH, Yan J, Fleischman S, Katz M, DeFrancesco M. Racial and ethnic disparities in hospital readmissions after delivery. Obstet Gynecol 2015; 126 (05) 1040-1047
    CrossrefPubMedGoogle Scholar
  • 16 Reddy UM, Rice MM, Grobman WA. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Serious maternal complications after early preterm delivery (24-33 weeks' gestation). Am J Obstet Gynecol 2015; 213 (04) 538.e1-538.e9
    CrossrefPubMedGoogle Scholar
  • 17 Lyndon A, Baer RJ, Gay CL, El Ayadi AM, Lee HC, Jelliffe-Pawlowski L. A population-based study to identify the prevalence and correlates of the dual burden of severe maternal morbidity and preterm birth in California. J Matern Fetal Neonatal Med 2019; 17: 1-9
    PubMedGoogle Scholar
  • 18 Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol 2016; 215 (01) 113.e1-113.e10
    CrossrefPubMedGoogle Scholar
  • 19 Centers for Disease Control and Prevention. Severe maternal morbidity in the United States. Published 2017. Accessed February 28, 2018 at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html
    Google Scholar
  • 20 Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 2012; 120 (05) 1029-1036
    CrossrefPubMedGoogle Scholar
  • 21 Main EK, Abreo A, McNulty J. et al. Measuring severe maternal morbidity: validation of potential measures. Am J Obstet Gynecol 2016; 214 (05) 643.e1-643.e10
    CrossrefPubMedGoogle Scholar
  • 22 Lewkowitz AK, Rosenbloom JI, Keller M. et al. Association between stillbirth ≥23 weeks gestation and acute psychiatric illness within 1 year of delivery. Am J Obstet Gynecol 2019; 221 (05) 491.e1-491.e22
    CrossrefPubMedGoogle Scholar
  • 23 Rådestad I, Nordin C, Steineck G, Sjögren B. A comparison of women's memories of care during pregnancy, labour and delivery after stillbirth or live birth. Midwifery 1998; 14 (02) 111-117
    CrossrefPubMedGoogle Scholar
  • 24 ACOG Committee on Practice Bulletins. ACOG practice bulletin no. 102: management of stillbirth. Obstet Gynecol 2009; 113 (03) 748-761
    CrossrefPubMedGoogle Scholar
  • 25 ACOG committee opinion no. 736: optimizing postpartum care. Obstet Gynecol 2018; 131 (05) e140-e150
    CrossrefPubMedGoogle Scholar
  • 26 Lydon-Rochelle MT, Holt VL, Cárdenas V. et al. The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data. Am J Obstet Gynecol 2005; 193 (01) 125-134
    CrossrefPubMedGoogle Scholar
  • 27 Sørensen MJ, Kjaersgaard MIS, Pedersen HS. et al. Risk of fetal death after treatment with antipsychotic medications during pregnancy. PLoS One 2015; 10 (07) e0132280
    CrossrefPubMedGoogle Scholar
  • 28 Shlomi Polachek I, Fung K, Putnam K, Meltzer-Brody S, Vigod SN. A latent class analysis of brief postpartum psychiatric hospital admissions. Psychiatry Res 2018; 262 (262) 452-458
    CrossrefPubMedGoogle Scholar
  • 29 Getahun D, Ananth CV, Kinzler WL. Risk factors for antepartum and intrapartum stillbirth: a population-based study. Am J Obstet Gynecol 2007; 196 (06) 499-507
    CrossrefPubMedGoogle Scholar