Emergency Maternal Hospital Readmissions in the Postnatal Period: A Population-Based Cohort Study.
cohort
maternal
postnatal
readmission
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
18 Sep 2024
18 Sep 2024
Historique:
revised:
25
07
2024
received:
11
04
2024
accepted:
28
08
2024
medline:
18
9
2024
pubmed:
18
9
2024
entrez:
18
9
2024
Statut:
aheadofprint
Résumé
To determine the change in English emergency postnatal maternal readmissions 2007-2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS). National cohort study. All English National Health Service hospitals. A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017. Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database. Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS. A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28-1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31-1.39); age < 20 years (aOR 1.09, 95% CI 1.05-1.12); 40+ years (aOR 1.07, 95% CI 1.03-1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91-0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82-1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53-1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06-2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83-2.21). The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those <20 and ≥40 years old; primiparous women; and those with specified obstetric risk factors.
Identifiants
pubmed: 39291340
doi: 10.1111/1471-0528.17955
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIHR Applied Research Collaboration West Midlands
Informations de copyright
© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Références
World Health Organisation Guidelines Review Committee, WHO Technical Consultation on Postpartum and Postnatal Care (Geneva, Switzerland: World Health Organization, 2010).
J. Dol, B. Hughes, M. Bonet, et al., “Timing of Maternal Mortality and Severe Morbidity During the Postpartum Period: A Systematic Review,” JBI Evidence Synthesis 20, no. 9 (2022): 2119–2194.
E. Wall‐Wieler, S. L. Carmichael, M. L. Urquia, C. Liu, and A. Hjern, “Severe Maternal Morbidity and Postpartum Mental Health‐Related Outcomes in Sweden: A Population‐Based Matched‐Cohort Study,” Archives of Women's Mental Health 22, no. 4 (2019): 519–526.
S. Meaney, J. E. Lutomski, L. O'Connor, K. O'Donoghue, and R. A. Greene, “Women's Experience of Maternal Morbidity: A Qualitative Analysis,” BMC Pregnancy and Childbirth 16, no. 1 (2016): 184.
P. S. Moran, F. Wuytack, M. Turner, et al., “Economic Burden of Maternal Morbidity—A Systematic Review of Cost‐of‐Illness Studies,” PLoS One 15, no. 1 (2020): e0227377.
NMPA Project Team, “National Maternity and Perinatal Audit,” Clinical Report 2018, 2017.
NMPA Project Team, “National Maternity and Perinatal Audit: Clinical Report,” Based on Births in NHS Maternity Services in England and Wales Between 1 April 2018 and 31 March 2019, 2022.
Gov.uk, “Ethnicity Facts and Figures,” 2023.
Care Quality Commission, “Maternity Survey 2023,” 2024.
NHS Digital, “NHS Maternity Statistics 2021–2022 Hospital Episode Statistics,” 2022.
M. L. Pettersson, E. Nedstrand, M. Bladh, A. S. Svanberg, C. Lampic, and G. Sydsjö, “Mothers Who Have Given Birth at an Advanced Age—Health Status Before and After Childbirth,” Scientific Reports 10, no. 1 (2020): 9739.
Office for National Statistics, Births by Parents' Country of Birth (England and Wales, UK: Office for National Statistics, 2021).
M. Nair, J. J. Kurinczuk, and M. Knight, “Ethnic Variations in Severe Maternal Morbidity in the UK—A Case Control Study,” PLoS One 9, no. 4 (2014): e95086.
M. Lydon‐Rochelle, V. L. Holt, D. P. Martin, and T. R. Easterling, “Association Between Method of Delivery and Maternal Rehospitalization,” Journal of the American Medical Association 283, no. 18 (2000): 2411–2416.
N. Digital, “NHS Maternity Statistics—England, 2011–2012,” 2012.
N. Digital, “NHS Maternity Statistics, England—2021–22,” 2022.
N. Digital, “NHS Maternity Statistics, England 2016–17,” 2017.
M. Redshaw and K. Heikkila, Delivered With Care: A National Survey of Women's Experience of Maternity Care 2010 (London, UK: Oxford, 2010).
Healthcare Commission, Towards Better Births: A Review of Maternity Services in England (London, UK: Healthcare Commission, 2008).
A. Macfarlane, M. Mugford, and J. Henderson, Birth Counts: Statistics of Pregnancy and Childbirth (London, UK: Stationery Office, 2000).
E. Jones, F. Stewart, B. Taylor, P. G. Davis, and S. J. Brown, “Early Postnatal Discharge From Hospital for Healthy Mothers and Term Infants,” Cochrane Database of Systematic Reviews 6, no. 6 (2021): Cd002958.
S. Liu, M. Heaman, M. S. Kramer, et al., “Length of Hospital Stay, Obstetric Conditions at Childbirth, and Maternal Readmission: A Population‐Based Cohort Study,” American Journal of Obstetrics and Gynecology 187, no. 3 (2002): 681–687.
J. B. Ford, C. S. Algert, J. M. Morris, and C. L. Roberts, “Decreasing Length of Maternal Hospital Stay Is Not Associated With Increased Readmission Rates,” Australian and New Zealand Journal of Public Health 36, no. 5 (2012): 430–434.
NICE, “Postnatal Care NG 194,” 2021.
National Guideline Alliance, NICE Evidence Reviews Collection. Length of Postpartum Stay: Postnatal Care: Evidence Review A (London, UK: National Institute for Health and Care Excellence (NICE), 2021).
J. Shakespeare, E. Duff, and D. Bick, “How Many More Reviews Are Needed? Joined‐Up Policy and Investment in England's Maternity Units Is Needed Now to Improve Postnatal and Inter‐Pregnancy Care,” Midwifery 113 (2022): 103469.
Strengthening the Reporting of Observational Studies in Epidemiology, “STROBE Statement—Checklist of Items That Should Be Included in Reports of Cohort Studies,” 2024.
“Birth Characteristics in England and Wales,” 2021, https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthcharacteristicsinenglandandwales.
“Private Maternity Hospitals and Facilities,” 2019.
H. E. Knight, I. Gurol‐Urganci, T. A. Mahmood, et al., “Evaluating Maternity Care Using National Administrative Health Datasets: How Are Statistics Affected by the Quality of Data on Method of Delivery?,” BMC Health Services Research 13 (2013): 200.
J. E. Jardine, A. Frémeaux, M. Coe, I. Gurol Urganci, D. Pasupathy, and K. Walker, “Validation of Ethnicity in Administrative Hospital Data in Women Giving Birth in England: Cohort Study,” BMJ Open 11, no. 8 (2021): e051977.
R. E. Ghosh, D. C. Ashworth, A. L. Hansell, K. Garwood, P. Elliott, and M. B. Toledano, “Routinely Collected English Birth Data Sets: Comparisons and Recommendations for Reproductive Epidemiology,” Archives of Disease in Childhood. Fetal and Neonatal Edition 101, no. 5 (2016): F451–F457.
StataCorp, Stata Statistical Software: Release 17 (College Station, TX: StataCorp LLC, 2021).
M. A. Clapp, S. E. Little, J. Zheng, and J. N. Robinson, “A Multi‐State Analysis of Postpartum Readmissions in the United States,” American Journal of Obstetrics and Gynecology 215 (2016): 113.e1–113.e10.
J. L. Matas, L. E. Mitchell, S. V. Sharma, J. M. Louis, and J. L. Salemi, “Severe Maternal Morbidity at Delivery and Postpartum Readmission in the United States,” Paediatric and Perinatal Epidemiology 35, no. 6 (2021): 627–634.
M. Knight, K. Bunch, R. Patel, et al., Saving Lives, Improving Mothers' Care Core Report—Lessons Learned to Inform Maternity Care From the UK and Ireland Confidential Enquiries Into Maternal Deaths and Morbidity 2018–20 (Oxford, UK: National Perinatal Epidemiology Unit, University of Oxford, 2022).
The NHS Race and Heath Observatory, “Summary Report. Mapping Existing Policy Interventions to Tackle Ethnic Health Inequalities in Maternal and Neonatal Health in England: A Systematic Scoping Review With Stakeholder Engagement,” 2022.
NHS Digital, “Maternity Services Monthly Statistics, England—April 2017, Experimental Statistics,” 2017.
NHS Digital, “Maternity Services Monthly Statistics, Final March 2023, Provisional April 2023, Experimental Statistics,” 2023.
M. Amyx, M. Philibert, A. Farr, et al., “Trends in Caesarean Section Rates in Europe From 2015 to 2019 Using Robson's Ten Group Classification System: A Euro‐Peristat Study,” BJOG: An International Journal of Obstetrics and Gynaecology 131, no. 4 (2024): 444–454.
J. Hollowell, R. Rowe, J. Townend, et al., Health Services and Delivery Research. The Birthplace in England National Prospective Cohort Study: Further Analyses to Enhance Policy and Service Delivery Decision‐Making for Planned Place of Birth (Southampton, UK: NIHR Journals Library, 2015).
National Institute for Health and Care Excellence, “Intrapartum Care NG235,” 2023.
R. E. Rowe, R. Fitzpatrick, J. Hollowell, and J. J. Kurinczuk, “Transfers of Women Planning Birth in Midwifery Units: Data From the Birthplace Prospective Cohort Study,” BJOG: An International Journal of Obstetrics and Gynaecology 119, no. 9 (2012): 1081–1090.
F. Althabe, M. N. S. Therrien, V. Pingray, et al., “Postpartum Hemorrhage Care Bundles to Improve Adherence to Guidelines: A WHO Technical Consultation,” International Journal of Gynaecology and Obstetrics 148, no. 3 (2020): 290–299.
World Health Organization, WHO Recommendation on Routine Antibiotic Prophylaxis for Women Undergoing Operative Vaginal Birth (Geneva, Switzerland: World Health Organization, 2021).
M. Knight, V. Chiocchia, C. Partlett, et al., “Prophylactic Antibiotics in the Prevention of Infection After Operative Vaginal Delivery (ANODE): A Multicentre Randomised Controlled Trial,” Lancet 393, no. 10189 (2019): 2395–2403.
Royal College of Midwives, “RCM Warns of Midwife Exodus as Maternity Staffing Crisis Grows,” 2021.
Royal College of Obstetricians & Gyanecologists, “Reducing the Risk of Venous Thromboembolism During Pregnancy and the Puerperium,” Contract No.: Green‐Top Guideline No. 37a, 2015.
M. Pevzner and A. Dahan, “Mastitis While Breastfeeding: Prevention, the Importance of Proper Treatment, and Potential Complications,” Journal of Clinical Medicine 9, no. 8 (2020): 2328.
M. Wee, Headache After a Spinal or Epidural Injection (London, UK: Royal College of Anaesthetists (RCoA), Association of Anaesthetists of Great Britain and Ireland (AAGBI), 2015).
Society of Critical Care Medicine, “Surviving Sepsis Campaign,” 2024, https://www.sccm.org/SurvivingSepsisCampaign/Home.
Royal College of Obstetricians and Gynaecologists, “Bacterial Sepsis in Pregnancy Green‐Top Guideline No 64a,” 2012.
NHS WH, Ostetric Sepsis Pathway (London, UK: NHS WH, 2017).
NHS Greater Manchester and Eastern Cheshire Strategic Clinical Networks, “Management of Pre‐Term Pre‐Labour Rupture of Membranes (PPROM) Before 37 weeks Gestation Guideline,” 2023.
M. Abraham, S. Alramadhan, C. Iniguez, et al., “A Systematic Review of Maternal Smoking During Pregnancy and Fetal Measurements With Meta‐Analysis,” PLoS One 12, no. 2 (2017): e0170946.
E. Soto and R. Bahado‐Singh, “Fetal Abnormal Growth Associated With Substance Abuse,” Clinical Obstetrics and Gynecology 56, no. 1 (2013): 142–153.
A. Kimergård, M. Foley, Z. Davey, J. Dunne, C. Drummond, and P. Deluca, “Codeine Use, Dependence and Help‐Seeking Behaviour in the UK and Ireland: An Online Cross‐Sectional Survey,” QJM 110, no. 9 (2017): 559–564.
Institute of Health Visiting, “Health Visitor Workforce Numbers in England Reach an All‐Time Low,” 2022, https://ihv.org.uk/news‐and‐views/news/health‐visitor‐workforce‐numbers‐in‐england‐reach‐an‐all‐time‐low/.
C. MacDonald, S. Sharma, M. Kallioinen, and D. Jewell, “Postnatal Care: New NICE Guideline for the 'Cinderella Service',” British Journal of General Practice 71, no. 710 (2021): 394–395.
J. Henderson and M. Redshaw, “Change Over Time in Women's Views and Experiences of Maternity Care in England, 1995–2014: A Comparison Using Survey Data,” Midwifery 44 (2017): 35–40.