Abstract
BackgroundAs the rate of cesarean section delivery has increased, the incidence of severe maternal morbidity continues to increase. Severe maternal morbidity is associated with high medical costs, extended length of hospital stay, and long-term rehabilitation. However, there is no evidence whether severe maternal morbidity affects postpartum readmission. Therefore, this study aimed to determine the relationship between severe maternal morbidity and postpartum readmission.MethodsThis nationwide population-based cohort study used the Korean National Health Insurance Service-National Sample cohort of 90,035 delivery cases between January 2003 and November 2013. The outcome variable was postpartum readmission until 6 weeks after the first date of delivery in the hospital. Another variable of interest was the occurrence of severe maternal morbidity, which was determined using the Center for Disease Control and Prevention’s algorithm. The Cox proportional hazard model was used to assess the association between postpartum readmission and severe maternal morbidity after all covariates were adjusted.ResultsThe overall incidence of postpartum readmission was 2041 cases (0.95%) of delivery. Women with severe maternal morbidity had an approximately 2.4 times higher risk of postpartum readmission than those without severe maternal morbidity (hazard ratio 2.36, 95% confidence interval 1.75–3.19). In addition, compared with reference group, women who were aged 20–30 years, nulliparous, and delivered in a tertiary hospital were at high risk of postpartum readmission.ConclusionsSevere maternal morbidity was related to the risk of postpartum readmission. Policy makers should provide a quality indicator of postpartum maternal health care and improve the quality of intrapartum care.
Highlights
Compared with the maternal mortality ratio, severe maternal morbidity (SMM) is a useful indicator for the evaluation and improvement of maternal health services [1], and it use as such an indicator has increased
Several studies identified which factors affected postpartum readmission [5, 16,17,18], most of them focused on the relationship between postpartum readmission and the mode of delivery, and cesarean section (CS) was especially associate with postpartum readmission [16,17,18]
Of the 90,035 women included in this study, 2041 (2.27%) had SMM during the delivery hospitalization
Summary
Compared with the maternal mortality ratio, severe maternal morbidity (SMM) is a useful indicator for the evaluation and improvement of maternal health services [1], and it use as such an indicator has increased. Postpartum readmission was used as one of the indicators of postpartum maternal morbidity [6], but few researchers suggested that it could be a quality indicator in obstetric care [5]. This study aimed to determine whether SMM is related to the risk of postpartum readmission. As the rate of cesarean section delivery has increased, the incidence of severe maternal morbidity continues to increase. Severe maternal morbidity is associated with high medical costs, extended length of hospital stay, and long-term rehabilitation. There is no evidence whether severe maternal morbidity affects postpartum readmission. This study aimed to determine the relationship between severe maternal morbidity and postpartum readmission
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