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Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association Between Method of Delivery and Maternal Rehospitalization. JAMA. 2000;283(18):2411–2416. doi:10.1001/jama.283.18.2411
Author Affiliations: Department of Health Services, School of Public Health and Community Medicine (Drs Lydon-Rochelle and Martin); Department of Family and Child Nursing, School of Nursing (Dr Lydon-Rochelle); Department of Epidemiology, School of Public Health and Community Medicine (Dr Holt); and Department of Obstetrics and Gynecology, School of Medicine (Dr Easterling), University of Washington, Seattle.
Context Despite nearly 4 million deliveries in the United States each year,
minimal information exists on unintended health consequences following childbirth,
particularly in relation to delivery method.
Objective To assess the risk for maternal rehospitalization associated with cesarean
or assisted vaginal delivery compared with spontaneous vaginal delivery.
Design Retrospective cohort study of data from the Washington State Birth Events
Record Database for 1987 through November 1, 1996.
Setting and Participants All primiparous women without selected chronic medical conditions who
delivered live singleton infants in nonfederal short-stay hospitals in Washington
Main Outcome Measures Relative risks (RRs) of rehospitalization within 60 days of cesarean
or assisted vaginal vs spontaneous vaginal deliveries.
Results A total of 3149 women (1.2%) were rehospitalized within 60 days of delivery.
In logistic regression analyses adjusting for maternal age, rehospitalization
was found to be more likely among women with cesarean delivery (RR, 1.8; 95%
confidence interval [CI], 1.6-1.9) or assisted vaginal delivery (RR, 1.3;
95% CI, 1.2-1.4) than among women with spontaneous vaginal delivery. Cesarean
delivery was associated with significantly increased risks of rehospitalization
for uterine infection, obstetrical surgical wound complications, and cardiopulmonary
and thromboembolic conditions. Among women with assisted vaginal delivery,
significant increased risks were seen for rehospitalization with postpartum
hemorrhage, obstetrical surgical wound complications, and pelvic injury.
Conclusions Women with cesarean and assisted vaginal deliveries were at increased
risk for rehospitalization, particularly with infectious morbidities. Effective
strategies for preventing and controlling peripartum infection should be an
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