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

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).