Maternal risk factors for postpartum readmission following vacuum-assisted vaginal delivery: A retrospective cohort study.

OBJECTIVE

To identify risk factors associated with postpartum readmission following vacuum-assisted vaginal delivery.

METHODS

A retrospective cohort study at a single university-affiliated tertiary medical center from 2012 to 2023, including all singleton pregnancies delivered at ≥37 weeks' gestation. Women who underwent a vacuum-assisted vaginal delivery (VAD) trial were identified. Multiple gestations, nonviable fetuses, and failed VAD requiring emergency cesarean delivery (CD) were excluded. Participants were categorized as readmitted or not readmitted within 6 weeks postpartum for obstetrical or gynecologic indications. Univariate analysis followed by multivariate logistic regression determined risk factors for readmission.

RESULTS

Among 111 878 vaginal deliveries, 8730 (7.8%) involved VAD, with a readmission rate of 1.2% (105 women). Infectious causes accounted for 67.6% of readmissions. The most common infectious diagnosis was endometritis (27.6%), followed by urinary tract infection (14.3%), mastitis (12.4%), fever of unknown origin (8.6%), and infected laceration or episiotomy site (4.8%). Multivariate analysis revealed that pre-eclampsia (odds ratio [OR] = 5.0, 95% confidence interval [CI]: 2.2-11.0, P < 0.001), postpartum fever (OR = 3.4, 95% CI: 1.0-11.0, P = 0.036), previous CD (OR = 2.0, 95% CI: 1.0-4.0, P = 0.046), and persistent occiput posterior fetal position (OR = 1.9, 95% CI: 1.2-3.3, P = 0.013) were significant risk factors for readmission. Notably, the primary indications for VAD, such as prolonged second stage of labor and non-reassuring fetal heart rate monitoring, were not independently associated with an increased risk of postpartum readmission.

CONCLUSION

Several risk factors are associated with increased risk of postpartum readmission following VAD. Enhanced postpartum surveillance in these high-risk groups may help reduce readmissions and improve maternal outcomes.