Reproductive
Comorbidities and complications: how the effect of cesarean delivery on postpartum rehospitalization varies by condition Ruby Barnard-Mayers* Ruby Barnard-Mayers Eugene Declercq Eleanor J. Murray Christina D. Yarrington Martha M. Werler
Introduction: Numerous studies have linked having a cesarean delivery to an increased risk of maternal morbidities. However, there is a lack of information on how different indications for cesarean deliveries modify these effects.
Objective: We aimed to understand how different indications of cesarean delivery act as potential effect modifiers for the effect of cesarean delivery on postpartum rehospitalization among nulliparous, term, singleton, vertex pregnancies in Massachusetts.
Methods: Data for this study come from the Pregnancy to Early Life Longitudinal data system, which uses birth certificate and hospital discharge records from all deliveries in Massachusetts from 2011 to 2018. Cesarean delivery, the exposure of interest, was based on both the birth certificate and discharge records. Postpartum rehospitalization included observational and emergency visits between 2 and 365 days after delivery. We examined EMM for five subgroups: chronic/acute disease, fetal conditions, uteroplacental abnormality, labor complications, and no documented indication. Within each of these groups we calculated adjusted RRs and RDs for the effect of cesarean delivery, compared to vaginal delivery, on rehospitalization adjusting for demographic and pregnancy characteristics.
Results: The risk of rehospitalization for vaginal deliveries was 20.5% for vaginal deliveries and ranged from 18% to 24% across the 5 indication groups for cesareans. The smallest effects were identified among birthing people with no indication (aRD: 0.05%) and with any chronic or infectious disease (aRD: 0.09%). The largest effect was among those with a uteroplacental abnormality (aRD: 2.91%; aRR: 1.22).
Discussion: We discovered modest evidence of EMM by indication for the effect of cesarean delivery on postpartum rehospitalization on both the relative and absolute scale. Our results suggest that birthing people with a uteroplacental or anatomic abnormality may benefit from a higher level of postpartum care.