References

Ade-Conde JA, Alabi O, Higgins S, Visvalingam G Maternal post natal hospital readmission-trends and association with mode of delivery. Ir Med J. 2011; 104:(1)17-20

Borders N After the afterbirth: a critical review of postpartum health relative to method of delivery. J Midwifery Womens Health. 2006; 51:(4)242-8

2014. http://tinyurl.com/jvfyrlb (accessed 11 April 2016)

Declercq E, Barger M, Cabral HJ, Evans SR, Kotelchuck M, Simon C, Weiss J, Heffner LJ Maternal outcomes associated with planned primary cesarean births compared with planned vaginal births. Obstet Gynecol. 2007; 109:(3)669-77

Devane D, Begley CM, Clarke M, Horey D, OBoyle C Evaluating maternity care: a core set of outcome measures. Birth. 2007; 34:(2)164-72

Gibbons L, Belizán JM, Lauer JA, Betrán AP, Merialdi M, Althabe FGeneva: World Health Organization; 2010

Healthcare Pricing Office. 2014. http://www.hse.ie/eng/services/publications/Perinatal_Statistics_Report_2013.pdf (accessed 11 April 2016)

Healthcare Pricing Office. Hospital In patient Enquiry (HIPE) Statistics Reporter. 2015. http://www.hpo.ie (accessed 20 March 2016)

Hofmeyr GJ, Barrett JF, Crowther CA Planned caesarean section for women with a twin pregnancy. Cochrane Database Syst Rev. 2015; 12 https://doi.org/10.1002/14651858.CD006553.pub3

Johnston G, Crombie IK, Davies HT, Alder EM, Millard A Reviewing audit: barriers and facilitating factors for effective clinical audit. Qual Health Care. 2000; 9:(1)23-36

Karlström A, Lindgren H, Hildingsson I Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. BJOG. 2013; 120:(4)479-86 https://doi.org/10.1111/1471-0528.12129

Kealy MA, Small RE, Liamputtong P Recovery after caesarean birth: a qualitative study of women's accounts in Victoria, Australia. BMC Pregnancy Childbirth. 2010; 10 https://doi.org/10.1186/1471-2393-10-47

Kenny C, Devane D, Normand C, Clarke M, Howard A, Begley C A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study). Midwifery. 2015; 31:(11)1032-8 https://doi.org/10.1016/j.midw.2015.06.012

Kok N, Ruiter L, Hof M, Ravelli A, Mol BW, Pajkrt E, Kazemier B Risk of maternal and neonatal complications in subsequent pregnancy after planned caesarean section in a first birth, compared with emergency caesarean section: a nationwide comparative cohort study. BJOG. 2014; 121:(2)216-23 https://doi.org/10.1111/1471-0528.12483

Liu S, Heaman M, Joseph KS, Liston RM, Huang L, Sauve R, Kramer MS Risk of maternal postpartum readmission associated with mode of delivery. Obstet Gynecol. 2005; 105:(4)836-42

Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007; 176:(4)455-60

Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR Association between method of delivery and maternal rehospitalization. JAMA. 2000; 283:(18)2411-6

Lydon-Rochelle MT, Holt VL, Martin DP Delivery method and self-reported postpartum general health status among primiparous women. Paediatr Perinat Epidemiol. 2001; 15:(3)232-40

Macfarlane AJ, Blondel B, Mohangoo AD, Cuttini M, Nijhuis J, Novak Z, lafsdóttir HS, Zeitlin J Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG. 2016; 123:(4)559-68 https://doi.org/10.1111/1471-0528.13284

2014. http://tinyurl.com/hnhut63 (accessed 11 April 2016)

2014. http://www.coombe.ie/index.php?nodeId=110 (accessed 11 April 2016)

Thompson JF, Roberts CL, Currie M, Ellwood DA Prevalence and persistence of health problems after childbirth: associations with parity and method of birth. Birth. 2002; 29:(2)83-94

Turnbull DA, Wilkinson C, Yaser A, Carty V, Svigos JM, Robinson JS Women's role and satisfaction in the decision to have a caesarean section. Med J Aust. 1999; 170:(12)580-3

Walker SP, McCarthy EA, Ugoni A, Lee A, Lim S, Permezel M Cesarean delivery or vaginal birth: a survey of patient and clinician thresholds. Obstet Gynecol. 2007; 109:(1)67-72

Wloch C, Wilson J, Lamagni T, Harrington P, Charlett A, Sheridan E Risk factors for surgical site infection following caesarean section in England: results from a multicentre cohort study. BJOG. 2012; 119:(11)1324-33 https://doi.org/10.1111/j.1471-0528.2012.03452.x

Readmission following caesarean section: Outcomes for women in an Irish maternity hospital

02 June 2016
12 min read
Volume 24 · Issue 5

Abstract

Background:

Women who give birth by caesarean section are more likely to require readmission to hospital following birth compared to women who give birth vaginally.

Aims:

To examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS).

Methods:

A retrospective audit of maternity records was undertaken.

Findings:

The total number of births for the period of data extraction was 8580, of which 2470 (28.79%) women gave birth by CS. A total of 107 women (4.33% of those who gave birth by CS) were readmitted to hospital between 1 August 2014 and 31 July 2015, of which 46 women (1.86%) were readmitted following elective CS and 61 (2.47%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights, respectively, and the average timeline for readmission was 14.6 days following elective CS and 15.7 following emergency CS. The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% following elective CS and n=51, 83.61% following emergency CS) and intravenous antibiotics (n=23, 50% following elective CS and n=34, 55.74% following emergency CS).

Conclusions:

Abdominal wound infection is one of the most common reasons for readmission of women to hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS.

Clinical audit has been regarded as a valuable asset to examine existing practices with an aim to improve quality of health care in future (Johnston et al, 2000). Rising rates of caesarean section (CS), with no improvements in maternal and neonatal morbidity, are a global concern (Zeitlin et al, 2013), and there is considerable variation from one country to another (Macfarlane et al, 2016).

Readmission to hospital following birth is considered to be a key indicator of maternal health (Lydon-Rochelle et al, 2000) and has been listed as one of the top 10 maternity care core outcome measures in a multinational Delphi survey (Devane et al, 2007). Women giving birth by CS are more than twice as likely as those who give birth vaginally to require readmission to hospital within 30 days of birth, primarily due to wound complications (Lydon-Rochelle et al, 2000; Thompson et al, 2002). Readmission to hospital post-CS was estimated to increase the cost of health care by 13% compared to readmission following vaginal birth, in a study of 244 088 women in Massachusetts, USA (Declercq et al, 2007). Analysis of data from 900 108 births in Canada for the years 1997/98 and 2000/01 showed that birthing by CS was associated with a fivefold increase in cardiac arrest (1.9% versus 0.4%), a fourfold increase in wound haematoma (13.0% versus 2.7%), a threefold increase in infection (6.0% versus 2.1%) and haemorrhage resulting in hysterectomy (0.3% versus 0.1%), and a twofold increase in anaesthetic complications (5.3% versus 2.1%) (Liu et al, 2007). Increased maternal and neonatal morbidities are associated with emergency CS, as well as when CS is performed without any medical indication (Karlström et al, 2013). The total cost of ‘excess’ CS in 2008, worldwide, was estimated to be approximately 5.4 times the cost of the ‘needed’ procedures (Gibbons et al, 2010).

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