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Women's Health

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Women who have c-sections or assisted vaginal deliveries are at increased risk for rehospitalization

In 1996, one in five pregnant women in the United States underwent cesarean delivery (c-section), and 14 percent had assisted vaginal deliveries (i.e., doctors used forceps or vacuum extraction). These women are more likely to be readmitted to the hospital, particularly for infections, than women who have uncomplicated vaginal deliveries, according to a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00034). University of Washington researchers linked Washington State birth data with hospital discharge data to determine the relative risk (RR) of rehospitalization within 2 months of delivery among women giving birth to their first child in a Washington hospital.

They found that 1.2 percent of women were rehospitalized within 2 months of delivery. After adjustment for maternal age, rehospitalization was more likely among women with cesarean delivery (RR, 1.8; equal risk is 1) or assisted vaginal delivery (RR, 1.3) than among women with spontaneous vaginal delivery. Compared with women who had spontaneous vaginal delivery, women who had c-sections were more apt to be rehospitalized with uterine infection (RR, 2), gallbladder disease (RR, 1.5), genitourinary tract conditions (RR, 1.5), obstetrical surgical wound complications (RR, 30.2), cardiopulmonary conditions (RR, 2.4), thromboembolic conditions (RR, 2.5), and appendicitis (RR, 1.8). Women who had assisted vaginal delivery had a greater risk than women with spontaneous vaginal delivery of rehospitalization for postpartum hemorrhage complications (RR, 1.3), genitourinary tract conditions (RR, 1.4), obstetrical surgical wound complications (RR, 4.2), and pelvic injury (RR, 2.5).

Infection was the predominant reason for rehospitalization. However, these findings also suggest that the level of mechanical trauma associated with assisted vaginal delivery (for example, anal sphincter tears, anal or urinary incontinence, and pain on intercourse) can be severe enough to necessitate postpartum rehospitalization. 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 "Association between method of delivery and maternal rehospitalization," by Mona Lydon-Rochelle, M.P.H., Ph.D., C.N.M., Victoria L. Holt, M.P.H., Ph.D., Diane P. Martin, M.A., Ph.D., and Thomas R. Easterling, M.D., in the May 10, 2000 Journal of the American Medical Association 283(18), pp. 2411-2416.

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