Search

The postnatal period (birth to 42 days postpartum) marks a high-risk time for maternal death and severe morbidity. This research aimed 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). A national cohort study including data from 6 192 140 women giving birth in English NHS hospitals 2007–17. Analyses used routinely collected birth and readmission data from the English National Hospital Episode Statistics (HES) database. Overall, HES provides high but varying quality data, with missing data in fields such as delivery mode (0·8%) and ethnicity (8·7%). Outcomes included annual rate of emergency postnatal maternal hospital readmissions related to pregnancy/birth and readmission diagnoses. Backwards stepwise logistic regression provided odds ratios for associations between risk of readmission and maternal demographic factors, obstetric risk factors (medical diagnoses/procedures during pregnancy/birth that may influence the likelihood of readmission), and LOS. Odds ratios were fully adjusted for all factors within the model. A significant increase in 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 1·28–1·36) 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); modes of birth other than spontaneous vaginal (emergency caesarean: aOR 1·86, 95% CI 1·82–1·90), birthing in a midwife-led ward (aOR 1·08, 95% CI 1·06–1·11); longer LOS (4+ vs 0 days: aOR 1·58, 95% CI 1·53–1·64) and obstetric risk factors. The concerning rise in emergency maternal readmissions should be addressed from a health inequalities perspective focusing on women from minoritised ethnic groups. Re-evaluating birth settings, including exploring women's choices and whether they are fully informed is also recommended. NIHR Applied Research Collaboration West Midlands. [ABSTRACT FROM AUTHOR]