Women Who Have Cesarean or
Assisted Vaginal Delivery More Likely to Be Readmitted to
Hospital.
From the Website Address:
http://womenshealth.medscape.com/MedscapeWire/2000/0500/medwire.0510.Women.html
May 10, 2000
JAMA/MedscapeWire
Women who have cesarean or assisted
vaginal delivery are at a higher risk of rehospitalization
within 60 days than women who have spontaneous (unassisted)
vaginal delivery, according to an article in the May 10
issue of The Journal of the American Medical
Association.
Mona Lydon-Rochelle, MPH, PhD, CNM,
from the University of Washington in Seattle and colleagues
examined the association between different delivery methods
and the risk of rehospitalization after delivery. The
researchers used data from 256,795 delivery records of
mothers who delivered a single live infant (multiple births,
such as twins were excluded, as were mothers with certain
chronic medical conditions) from the Washington State Birth
Events Record Database from 1987 through November 1, 1996.
These delivery records were matched with subsequent hospital
records.
The researchers found that a total
of 3149 women (1.2%) were rehospitalized within 60 days
after delivery. After adjusting for the age of the mother at
the time of delivery, women with cesarean deliveries were
1.8 times more likely to be rehospitalized and women with
assisted vaginal delivery (forceps or vacuum extraction were
used) were 1.3 times more likely to be rehospitalized than
women who had spontaneous vaginal delivery.
Cesarean delivery was associated
with increased risks of rehospitalizatin for:
- Uterine infection (2.0 times
higher than with spontaneous vaginal
delivery)
- Gallbladder disease (1.5 times
higher)
- Genitourinary tract conditions
(1.5 times higher)
- Obstetrical surgical wound
complications (30.2 times higher)
- Cardiopulmonary conditions (2.4
times higher)
- Thromboembolic conditions (2.5
times higher)
- Appendicitis (1.8 times higher)
Assisted vaginal delivery was
associated with increased risks of rehospitalization
for:
- Postpartum hemorrhage (1.3
times higher than with spontaneous vaginal
delivery)
- Obstetrical surgical wound
complications (4.2 times higher)
- Pelvic injury (2.5 times
higher)
"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 per 1000 cesarean procedures)," the authors write.
"Because surgical wounds occur in every instance among women
with cesarean delivery and episiotomy [incision to
facilitate vaginal delivery] does not occur with every
spontaneous vaginal delivery, a higher risk for
rehospitalization for surgical wound infection may be
expected among women with cesarean delivery."
"Identification of factors that can
amend rehospitalization risk remains a complex undertaking,"
according to the authors. "Our most important finding, that
women with cesarean and assisted vaginal delivery were at
increased risk for rehospitalization with infectious
morbidities, suggests that even more rigorous attention to
effective peripartum infection prevention and control
strategies should be an obstetrical care
priority."
According to background information
in the article, in 1996, 21.8% of the approximately 3.9
million deliveries in the United States were by cesarean
section, 14.4% were assisted vaginal deliveries, and the
remaining 63.8% were spontaneous vaginal
deliveries.
JAMA. 2000;283:2411-2416
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