Society for Maternal-Fetal Medicine Special Statement: A critique of postpartum readmission rate as a quality metric

Combs, C. Andrew; Goffman, Dena; Pettker, Christian M.

doi:10.1016/j.ajog.2021.11.1355

Cited by 15 publications

(20 citation statements)

References 66 publications

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“… 11 However, medical conditions, such as HDP, are associated with higher rates of postpartum readmission. 5 , 16 During our study period, the readmission rate due to HDP was about 0.16%, which is lower than readmission rates from previous studies ranging from 0.4-9.3%. 2 , 6 Although the LOS between groups during the delivery admission were similar, an outpatient HDP management protocol for postpartum patients with HDP was continued after implementation of the early discharge policy to adhere with ACOG recommendations.…”

Section: Resultscontrasting

confidence: 56%

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

Griffin

Black

Deeb

et al. 2022

AJOG Global Reports

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Section: Resultscontrasting

confidence: 56%

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

Griffin

Black

Deeb

et al. 2022

AJOG Global Reports

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“…Limitations of this study include the lack of information about the dose of aspirin, when it was initiated and discontinued, and whether patients actually took aspirin. Tracking the use of LDA for prevention of PE is challenging because aspirin is available over the counter and is not always prescribed when it is recommended in pregnancy 28 . Aspirin exposure in this study was based on documentation of a recommendation from the clinician in the medical record, which has been identified by the Society for Maternal–Fetal Medicine as a quality metric for high‐risk patients 28 .…”

Section: Discussionmentioning

confidence: 99%

Propensity score analysis of low‐dose aspirin and bleeding complications in pregnancy

Souter,

Painter,

Sitcov

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesLow dose aspirin has been shown to reduce the risk of preterm pre‐eclampsia and it has been suggested that it should be recommended for all pregnancies. However, some studies have reported an association between low dose aspirin and an increased risk of bleeding complications in pregnancy. Our aim was to evaluate the risk of placental abruption and postpartum hemorrhage (PPH) in patients for whom their healthcare provider had recommended prophylactic aspirin.MethodsThis multicenter cohort study included 72,598 singleton births at 19 U.S. hospitals (between January 2019 and December 2021). Pregnancies complicated by placenta previa/accreta, births occurring at less than 24 weeks’ gestation, multiple pregnancies, or missing data for aspirin recommendation were excluded. Propensity scores were calculated using 20 features spanning sociodemographic factors, medical history, year, and hospital providing care. The association between low dose aspirin recommendation and placental abruption or postpartum hemorrhage was estimated by inverse probability weighting using the propensity scores.ResultsWe included 71,627 pregnancies in the final analysis. Aspirin was recommended to 6,677 (9.3%) and was more likely to be recommended for pregnant individuals who were older (p<0.001), had a higher body mass index (BMI) (p<0.001), had pre‐pregnancy hypertension (p<0.001), and who did not have a spontaneous vaginal birth (p<0.001). Overall, 1,205 (1.7%) of the study cohort developed preterm preeclampsia: 1.3% in the no aspirin and 5.7% in the aspirin group. After inverse probability weighting with propensity scores, aspirin was associated with increased risk of placental abruption (adjusted OR 1.44; 95% CI 1.04, 2.00) and postpartum hemorrhage (adjusted OR 1.21; 95% CI, 1.05,1.39). The ‘number needed to harm’ with low dose aspirin was 1 in 79 (95% CI 1 in 43, 1 in 330) for postpartum hemorrhage and 1 in 287 (95% CI 1 in 127, 1 in 3151) for placental abruption.ConclusionsLow dose aspirin recommendation in pregnancy was associated with increased risk for placental abruption and for postpartum hemorrhage. Our results support the need for more research into aspirin and bleeding complications in pregnancy before recommending it beyond the highest risk pregnancies.This article is protected by copyright. All rights reserved.

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“…For quality of care, duration of postnatal stay is best matched against individual needs rather than being used a stand-alone quality metric. The risk of early postnatal readmissions is highest for those women who had severe intrapartum morbidity and, since patient factors account for most of the variance between hospitals, its use as an outcome quality metric has been questioned [35][36][37].…”

Section: Maternity Care Has Been Slow To Introduce and Adoptmentioning

confidence: 99%

Why anaesthetists should care about postnatal care

Bamber

2023

Anaesthesia

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Society for Maternal-Fetal Medicine Special Statement: A critique of postpartum readmission rate as a quality metric

Cited by 15 publications

References 66 publications

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

Propensity score analysis of low‐dose aspirin and bleeding complications in pregnancy

Why anaesthetists should care about postnatal care

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