Reports From The Field-Women's health

Women with assisted births run readmission risk

Women who deliver by cesarean or assisted vaginal delivery are much more likely to be readmitted for post-delivery complications than women who have spontaneous vaginal deliveries, according to a recent study in the Journal of the American Medical Association.

Researchers in Washington state linked state birth data to determine the relative risk of readmission within two months of delivery among women giving birth to their first child in a Washington hospital.

Findings include the following:

• 1.2% of women were readmitted within two months of delivery.

• After adjusting for maternal age, women who delivered by cesarean had a relative risk of 1.8% of readmission, and women who had assisted vaginal deliveries had a 1.3% relative risk of readmission.

• The most common reasons for readmission among women delivering by cesarean were uterine infection, gallbladder disease, genitourinary tract conditions, and obstetrical surgical wound complications.

• The most common reasons for readmission among women with assisted vaginal deliveries were postpartum hemorrhage complications, genitourinary tract conditions, obstetrical surgical wound complications, and pelvic injury.

Trauma factor

In both groups, infection was the predominant cause for readmission. However, researchers say the findings suggest that the level of mechanical trauma associated with assisted vaginal delivery (for example, anal sphincter tears, anal or urinary incontinence, and pain during intercourse) can be severe enough to necessitate postpartum readmission.

The researchers suggest that physicians find effective ways to prevent and control peripartum infection. They also recommend that physicians selectively substitute vacuum extraction for forceps, restrict use of episiotomy, and use effective suture techniques to decrease risk of pelvic injury or wound complications among women with assisted vaginal deliveries.

[See: Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. JAMA 2000; 283:2,411-2,416.]