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Women who have Caesarean or assisted vaginal delivery are more likely to be rehospitalized, UW study says

May 08, 2000

Women who have Caesarean or assisted vaginal delivery are at a higher risk of rehospitalization than women who have unassisted vaginal delivery, say University of Washington researchers. That's even when the mother's age, medical and pregnancy complications, and other factors are taken into account.

While it is known that various forms of delivery can lead to complications, what has not been reported before are the reasons and rates at which complications might land women in a hospital. For example, women with Caesarean delivery had a great risk of rehospitalization for uterine infection, obstetrical surgical wound complications, gallbladder complications, appendicitis, and cardio-pulmonary conditions.

Women with assisted vaginal delivery -- such as when forceps are used -- had a greater risk than others for rehospitalization with postpartum hemorrhage, obstetrical surgical wound complications and pelvic injury.

The findings are published in the May 10 issue of The Journal of the American Medical Association (JAMA).

The findings are timely in that Congress will be holding hearings on May 15 -- the Monday after Mother's Day -- on the Safe Motherhood Monitoring and Prevention Research Act. The bill appropriates funds for monitoring and preventing maternal disability and death. The study says women who have Caesareans are 80 percent more likely to be rehospitalized. Women who've had assisted vaginal delivery are 30 percent more likely. But it is important to note that only 1.2 percent of women are hospitalized after delivery, a relatively small number.

"Given that rehospitalization carries substantial consequences, including high economic costs, the disruption of early parenting and increased family burden, we think the message here is to encourage health care providers to look for even more ways to prevent infection before, during and after childbirth," says the lead author, Dr. Mona Lydon-Rochelle, a senior research fellow in the UW School of Nursing.

Even though nearly 4 million babies are delivered in the United States every year, there is little information about the unintended health consequences following any given delivery method. The researchers used data of mothers who delivered a single live infant, from 256,795 delivery records in a Washington state database for 1987 through 1996. These delivery records were matched with subsequent hospital records. The authors attempted to exclude women whose pre-existing medical conditions might have put them at greater odds of having a Caesarean, and thus perhaps at greater odds of being rehospitalized.

The authors said their most notable finding was the 30-fold increased risk associated with obstetrical surgical wound infection. That makes sense, since every Caesarean involves surgery. "However, the rate of rehospitalization for wound infection among women with Caesarean delivery was still quite low -- four per 1,000 Caesarean procedures," Lydon-Rochelle says. Lydon-Rochelle said the authors recommend that health care providers look for ways to avoid Caesarean or assisted vaginal delivery, and show even more rigorous attention to preventing infection.

"Prevention and control strategies should be an obstetrical care priority," she says.
Other authors include Dr. Victoria Holt, associate professor of epidemiology; Dr. Diane Martin, professor of health services; and Dr. Thomas Easterling, associate professor of obstetrics and gynecology. Lydon-Rochelle was supported in part by grants from the Agency for Health Care Policy and Research, the National Institutes of Health-National Institute of Nursing Research, the University of Washington School of Nursing and the Case Western Reserve Frances Payne Bolton Research Alumni Award.

University of Washington

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