Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA.
J Matern Fetal Neonatal Med. 2021 Jan;34(2):187-194. doi: 10.1080/14767058.2019.1601697. Epub 2019 Apr 9.
This study had two objectives: (i) to evaluate risk factors for postpartum readmission for a primary diagnosis of postpartum hemorrhage (PPH) among all women, and (ii) to determine risk for postpartum readmission specifically among women with PPH during their delivery hospitalization. The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for 2010 to 2014 was used to evaluate risk for postpartum readmission for PPH within 60 days of discharge from a delivery hospitalization. Obstetric, medical, demographic, and hospital factors including PPH during the index delivery were analyzed. Sixty-day postpartum readmission for PPH was the primary outcome. Both unadjusted and adjusted analyses were performed. In adjusted models, the risk was characterized as adjusted risk ratios (aRR) with 95% confidence intervals (CI). As a secondary outcome to further characterize how PPH at delivery was associated with readmission likelihood, the risk for all-cause readmission was evaluated among women with this diagnosis during their delivery. Of the 15,701,150 delivery hospitalizations, 10,618 women were readmitted postpartum for a primary indication of postpartum hemorrhage. Eighty-two percent of readmissions occurred ≤20 days after discharge. In the adjusted model for readmission for PPH, PPH during the delivery hospitalization was associated with aRR of 5.26 (95% CI 4.94, 5.59) for hemorrhage alone, aRR of 14.28 (95% CI 13.06, 15.60) for hemorrhage requiring transfusion, and aRR of 12.40 for PPH with disseminated intravascular coagulation (DIC) requiring transfusion (95% CI 9.56-16.08) compared to no PPH. For the secondary analysis evaluating all-cause readmission, PPH during delivery was associated with aRR of 1.47 for PPH alone (95% CI 1.44-1.51), aRR of 2.43 for PPH requiring transfusion (95% CI 2.34-2.52), and aRR of 2.77 for PPH with DIC requiring transfusion (95% CI 2.54-3.03) compared to no PPH. PPH at delivery is a significant risk factor for subsequent readmission both for PPH and for all causes. For women who undergo large hemorrhage during delivery, shorter interval postpartum follow-up may be indicated.
(i) 评估所有女性产后因产后出血（PPH）初次诊断而再次入院的风险因素，(ii) 确定分娩住院期间 PPH 女性再次入院的风险。使用 2010 年至 2014 年全国再入院数据库评估产后 60 天内 PPH 再次入院的风险。分析了产科、医疗、人口统计学和医院因素，包括指数分娩期间的 PPH。60 天产后 PPH 再次入院是主要结局。进行了未调整和调整分析。在调整模型中，风险特征为调整后的风险比(aRR)和 95%置信区间(CI)。作为进一步描述分娩时 PPH 与再入院可能性之间关系的次要结局，评估了患有该诊断的女性在分娩期间因其他原因再次入院的风险。在 15701150 例分娩住院中，有 10618 例女性因产后出血的主要原因再次入院。82%的再入院发生在出院后≤20 天内。在 PPH 再次入院的调整模型中，分娩期间的 PPH 与单独出血的 aRR 为 5.26(95%CI 4.94,5.59)，需要输血的 aRR 为 14.28(95%CI 13.06,15.60)，需要输血的 PPH 伴弥散性血管内凝血(DIC)的 aRR 为 12.40(95%CI 9.56-16.08)，而无 PPH 的 aRR 为 12.40。对于评估其他原因再入院的次要分析，分娩时的 PPH 与单独 PPH 的 aRR 为 1.47(95%CI 1.44-1.51)，需要输血的 PPH 的 aRR 为 2.43(95%CI 2.34-2.52)，需要输血的 PPH 伴 DIC 的 aRR 为 2.77(95%CI 2.54-3.03)，而无 PPH 的 aRR 为 2.77。分娩时的 PPH 是再次入院的一个重要危险因素，无论是 PPH 还是其他原因。对于在分娩期间经历大量出血的女性，可能需要更短的产后随访间隔。
