Researchers: Adel Farhi¹, Galit Hirsh-Yechzkel¹, Liat Lerner-Geva²

Background: The postpartum period of six weeks following childbirth, is associated with a significant increase in readmission rates.

Objectives: To evaluate the possible associations between sociodemographic, clinical, and obstetric variables and postpartum readmission.

Method: A retrospective cohort study was conducted. The cohort included women that delivered between 2017 and 2020 at four medical centers in Israel. Data was extracted from the medical records, followed by data cleaning, merging, and harmonization to create a unified dataset. The reasons for readmission were examined, in two time-periods (6 weeks and 6 months following delivery). Risk factors were analyzed using univariate and multivariate analyses.

Findings: The cohort included 112,136 live births. The overall postpartum readmission rate was 1.6% (ranging from 1.0% to 2.7% across hospitals). Most women (approximately 70%), were readmitted within two weeks of delivery. The primary causes for readmission within the first 6 weeks were pregnancy-related conditions (hemorrhage, suture infections, retained placenta). Further processing of data from the Sheba Medical Center revealed several variables associated with readmission: In vitro fertilization pregnancy (ORadj 1.41; 95%CI [1.05-1.68]), cesarean delivery (ORadj 1.36; 95%CI [1.10-1.67]), pregnancy at risk (ORadj 1.34; 95%CI [1.07-1.68]) preterm birth (ORadj 1.39; 95%CI [1.03-1.87]), thrombocytopenia (ORadj 1.35; 95%CI [1.0-1.76]), and first birth (ORadj 1.35; 95%CI [1.02-1.79]).

Conclusions: Several maternal characteristics were found to be associated with an increased readmission such as women who underwent IVF, cesarean delivery, primiparity and preterm birth. The possible association with preterm birth could be due to maternal diagnoses that either caused preterm birth or led to the decision for early delivery.

Recommendations: Develop targeted follow-up programs for women at high risk of postpartum readmission. Educate healthcare providers to identify risk factors for readmission and provide adequate support to postpartum women. Raise awareness among women about the importance of postpartum medical follow-up.

Research end date: 05/2024