Pritchett Ruth V, Rudge Gavin, Taylor Beck, Cummins Carole, Kenyon Sara, Jones Ellie, Morad Sharon, MacArthur Christine, Jolly Kate
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
BJOG. 2025 Jan;132(2):178-188. doi: 10.1111/1471-0528.17955. Epub 2024 Sep 18.
To determine the change in English emergency postnatal maternal readmissions 2007-2017 (pre-COVID-19) and the association with maternal demographics, obstetric risk factors and postnatal length of stay (LOS).
National cohort study.
All English National Health Service hospitals.
A total of 6 192 140 women who gave birth in English NHS hospitals from April 2007 to March 2017.
Statistical analysis using birth and readmission data from routinely collected National Hospital Episode Statistics (HES) database.
Rate of emergency postnatal maternal hospital readmissions related to pregnancy or giving birth within 42 days postpartum, readmission diagnoses and association with maternal demographic factors, obstetric risk factors and postnatal LOS.
A significant increase in the rate of emergency postnatal maternal readmissions from 15 128 (2.5%) in 2008 to 20 734 (3.4%) in 2016 (aOR 1.32, 95% CI 1.28-1.37) was found. Risk factors for readmission included minoritised ethnicity (particularly Black or Black British ethnicity: aOR 1.35, 95% CI 1.31-1.39); age < 20 years (aOR 1.09, 95% CI 1.05-1.12); 40+ years (aOR 1.07, 95% CI 1.03-1.10); primiparity (multiparity: aOR 0.92, 95% CI 0.91-0.93); nonspontaneous vaginal birth modes (emergency caesarean: aOR 1.86, 95% CI 1.82-1.90); longer LOS (4+ vs. 0 days: aOR 1.58, 95% CI 1.53-1.64); and obstetric risk factors including urinary retention (aOR 2.34, 95% CI 2.06-2.53) and postnatal wound breakdown (aOR 2.01, 95% CI 1.83-2.21).
The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups; those < 20 and ≥ 40 years old; primiparous women; and those with specified obstetric risk factors.
确定2007 - 2017年（新冠疫情前）英国产后产妇急诊再入院情况的变化，以及与产妇人口统计学特征、产科风险因素和产后住院时间（LOS）的关联。
全国队列研究。
英国所有国民健康服务医院。
2007年4月至2017年3月在英国国民健康服务医院分娩的6192140名妇女。
使用常规收集的国家医院事件统计（HES）数据库中的出生和再入院数据进行统计分析。
产后42天内与妊娠或分娩相关的产妇急诊再入院率、再入院诊断以及与产妇人口统计学因素、产科风险因素和产后住院时间的关联。
发现产后产妇急诊再入院率从2008年的15128例（2.5%）显著增加到2016年的20734例（3.4%）（调整后比值比1.32，95%置信区间1.28 - 1.37）。再入院的风险因素包括少数族裔（特别是黑人或英国黑人族裔：调整后比值比1.35，95%置信区间1.31 - 1.39）；年龄<20岁（调整后比值比1.09，95%置信区间1.05 - 1.12）；40岁及以上（调整后比值比1.07，95%置信区间1.03 - 1.10）；初产（经产：调整后比值比0.92，95%置信区间0.91 - 0.93）；非自然阴道分娩方式（急诊剖宫产：调整后比值比1.86，95%置信区间1.82 - 1.90）；住院时间较长（4天及以上与0天相比：调整后比值比1.58，95%置信区间1.53 - 1.64）；以及产科风险因素，包括尿潴留（调整后比值比2.34，95%置信区间2.06 - 2.53）和产后伤口裂开（调整后比值比2.01，95%置信区间1.83 - 2.21）。
应从健康不平等角度解决令人担忧的产妇急诊再入院率上升问题，重点关注少数族裔妇女；年龄<20岁和≥40岁的妇女；初产妇；以及有特定产科风险因素的妇女。
