(814) Risk of Postpartum Readmission: A Comparison between Stillbirths and Live Births

Stillbirth is associated with high rates of maternal/obstetric complications and psychiatric impact, which may increase patients’ risk for readmission. This study aimed to examine rate of postpartum readmission after stillbirth (vs. live birth) and associated risk factors and indications.

Study Design:

This is a retrospective cohort study using 2019 Nationwide Readmissions Database (NRD). Patients with singleton stillbirths and live births delivered at ≥ 20 weeks gestation in January-October 2019 were identified by diagnosis/procedure codes. Primary outcome was readmission in the subsequent 6 weeks. Principal diagnosis code of readmission was grouped by disease category. The association between stillbirth (vs. live birth) and risk of readmission was assessed using multivariable regression adjusting for maternal age, gestational age, comorbidities, mode of delivery, severe maternal morbidity (SMM) during delivery, and sociodemographic factors. Nationally representative estimates were generated by accounting for the complex sample design of NRD.

Results:

Sample included 16,967 stillbirths and 2,881,101 live births with differing baseline characteristics (Table). Readmission within 6 weeks postpartum occurred in 2.9% (n=498) and 1.6% (n=46,379) of patients with stillbirths and live births, respectively (p < 0.001). The higher risk of readmission after stillbirth persisted in multivariable regression (adjusted RR: 1.29, 95% CI: 1.13-1.48). Patients with stillbirths were more likely than those with live births to be readmitted for venous thromboembolism (5.1% vs. 2.0%, p=0.001) but less likely to be readmitted for hypertension (26.5% vs. 39.2%, p< 0.001) or gastrointestinal diseases (5.3% vs. 9.0%, p=0.047) (Figure). Among patients with stillbirths, hypertensive disorders of pregnancy, pre-existing diabetes, and SMM were associated with a higher risk for readmission.  

Conclusion:

In this large national cohort, risk of postpartum readmission was higher after stillbirth than live birth. Addressing identified risk factors and common indications for readmission may inform targeted interventions for prevention.