Original Research| Volume 3, ISSUE 4, 100345, July 2021

Risk factors for postpartum readmission among women after having a stillbirth


      Compared to women with a live birth, women with a stillbirth are more likely to have maternal complications during pregnancy and at birth, but risk factors related to their postpartum health are uncertain.


      This study aimed to identify patient-level risk factors for postpartum hospital readmission among women after having a stillbirth.


      This was a population-based cohort study of 29,654 women with a stillbirth in California from 1997 to 2011. Using logistic regression models, we examined the association of maternal patient-level factors with postpartum readmission among women after a stillbirth within 6 weeks of hospital discharge and between 6 weeks and 9 months after delivery.


      Within 6 weeks after a stillbirth, 642 women (2.2%) had a postpartum readmission. Risk factors for postpartum readmission after a stillbirth were severe maternal morbidity excluding transfusion (adjusted odds ratio, 3.02; 95% confidence interval, 2.28–4.00), transfusion at delivery but no other indication of severe maternal morbidity (adjusted odds ratio, 1.95; 95% confidence interval, 1.35–2.81), gestational hypertension or preeclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54–2.42), prepregnancy hypertension (adjusted odds ratio, 1.80; 95% confidence interval, 1.36–2.37), diabetes mellitus (adjusted odds ratio, 1.78; 95% confidence interval, 1.33–2.37), antenatal hospitalization (adjusted odds ratio, 1.78; 95% confidence interval, 1.43–2.21), cesarean delivery (adjusted odds ratio, 1.73; 95% confidence interval, 1.43–2.21), long length of stay in the hospital after delivery (>2 days for vaginal delivery and >4 days for cesarean delivery) (adjusted odds ratio, 1.59; 95% confidence interval, 1.33–1.89), non-Hispanic black race and ethnicity (adjusted odds ratio, 1.38; 95% confidence interval, 1.08–1.76), and having less than a high school education (adjusted odds ratio, 1.35; 95% confidence interval, 1.02–1.80). From 6 weeks to 9 months, 1169 women (3.90%) had a postpartum readmission; significantly associated risk factors were largely similar to those for earlier readmission.


      Women with comorbidities, with birth-related complications, of non-Hispanic black race and ethnicity, or with less education had increased odds of postpartum readmission after having a stillbirth, highlighting the importance of continued care for these women after discharge from the hospital.

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        • Centers for Disease Control and Prevention
        What is stillbirth?.
        2019 (Available at:)
        Date accessed: February 11, 2020
        • MacDorman MF
        • Gregory EC
        Fetal and perinatal mortality: United States, 2013.
        Natl Vital Stat Rep. 2015; 64: 1-24
        • Kilpatrick SJ
        • Abreo A
        • Gould J
        • Greene N
        • Main EK
        Confirmed severe maternal morbidity is associated with high rate of preterm delivery.
        Am J Obstet Gynecol. 2016; 215: 233.e1-233.e7
        • Hogue CJ
        • Parker CB
        • Willinger M
        • et al.
        A population-based case-control study of stillbirth: the relationship of significant life events to the racial disparity for African Americans.
        Am J Epidemiol. 2013; 177: 755-767
        • Fretts R
        Stillbirth epidemiology, risk factors, and opportunities for stillbirth prevention.
        Clin Obstet Gynecol. 2010; 53: 588-596
        • Willinger M
        • Ko CW
        • Reddy UM
        Racial disparities in stillbirth risk across gestation in the United States.
        Am J Obstet Gynecol. 2009; 201: 469.e1-469.e8
        • Yao R
        • Ananth CV
        • Park BY
        • Pereira L
        • Plante LA
        Perinatal Research Consortium. Obesity and the risk of stillbirth: a population-based cohort study.
        Am J Obstet Gynecol. 2014; 210: 457.e1-457.e9
        • Bodnar LM
        • Parks WT
        • Perkins K
        • et al.
        Maternal prepregnancy obesity and cause-specific stillbirth.
        Am J Clin Nutr. 2015; 102: 858-864
        • Wall-Wieler E
        • Carmichael SL
        • Gibbs RS
        • et al.
        Severe maternal morbidity among stillbirth and live birth deliveries in California.
        Obstet Gynecol. 2019; 134: 310-317
        • Gold KJ
        • Mozurkewich EL
        • Puder KS
        • Treadwell MC
        Maternal complications associated with stillbirth delivery: a cross-sectional analysis.
        J Obstet Gynaecol. 2016; 36: 208-212
        • Friedman AM
        • Wright JD
        • Ananth CV
        • Siddiq Z
        • D'Alton ME
        • Bateman BT
        Population-based risk for peripartum hysterectomy during low- and moderate-risk delivery hospitalizations.
        Am J Obstet Gynecol. 2016; 215: 640.e1-640.e8
        • Burden C
        • Bradley S
        • Storey C
        • et al.
        From grief, guilt pain and stigma to hope and pride—a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth.
        BMC Pregnancy Childbirth. 2016; 16: 9
        • Hogue CJR
        • Parker CB
        • Willinger M
        • et al.
        The association of stillbirth with depressive symptoms 6-36 months post-delivery.
        Paediatr Perinat Epidemiol. 2015; 29: 131-143
        • Lewkowitz AK
        • Rosenbloom JI
        • Keller M
        • et al.
        Association between stillbirth ≥23 weeks gestation and acute psychiatric illness within 1 year of delivery.
        Am J Obstet Gynecol. 2019; 221 (491.e1–22)
        • Clapp MA
        • Little SE
        • Zheng J
        • Robinson JN
        A multi-state analysis of postpartum readmissions in the United States.
        Am J Obstet Gynecol. 2016; 215 (113.e1–10)
        • ACOG Practice Bulletin no
        102: management of stillbirth.
        Obstet Gynecol. 2009; 113: 748-761
        • ACOG Committee Opinion no
        736: optimizing postpartum care.
        Obstet Gynecol. 2018; 131: e140-e150
        • Aseltine Jr, RH
        • Yan J
        • Fleischman S
        • Katz M
        • DeFrancesco M
        Racial and ethnic disparities in hospital readmissions after delivery.
        Obstet Gynecol. 2015; 126: 1040-1047
        • Kyser KL
        • Lu X
        • Santillan DA
        • et al.
        The association between hospital obstetrical volume and maternal postpartum complications.
        Am J Obstet Gynecol. 2012; 207 (42.e1–17)
        • Clapp MA
        • Little SE
        • Zheng J
        • Robinson JN
        • Kaimal AJ
        The relative effects of patient and hospital factors on postpartum readmissions.
        J Perinatol. 2018; 38: 804-812
        • Harvey EM
        • Ahmed S
        • Manning SE
        • Diop H
        • Argani C
        • Strobino DM
        Severe maternal morbidity at delivery and risk of hospital encounters within 6 weeks and 1 year postpartum.
        J Womens Health (Larchmt). 2018; 27: 140-147
        • Wall-Wieler E
        • Butwick AJ
        • Gibbs RS
        • et al.
        Maternal health after stillbirth: postpartum hospital readmission in California.
        Am J Perinatol. 2020; ([Epub ahead of print])
        • Centers for Disease Control and Prevention
        Severe maternal morbidity in the United States.
        2017 (Available at:)
        • Nicholson H
        Maternity length of stay rules.
        National Conference of State Legislatures. 2018 (Available at:)
        • Girsen AI
        • Mayo JA
        • Datoc IA
        • et al.
        Preterm birth outcomes among Asian women by maternal place of birth.
        J Perinatol. 2020; 40: 758-766
        • Saito M
        • Lyndon A
        Use of traditional birth practices by Chinese women in the United States.
        MCN Am J Matern Child Nurs. 2017; 42: 153-159
        • Conroy K
        • Koenig AF
        • Yu YH
        • Courtney A
        • Lee HJ
        • Norwitz ER
        Infectious morbidity after cesarean delivery: 10 strategies to reduce risk.
        Rev Obstet Gynecol. 2012; 5: 69-77
        • Leth RA
        • Møller JK
        • Thomsen RW
        • Uldbjerg N
        • Nørgaard M
        Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women.
        Acta Obstet Gynecol Scand. 2009; 88: 976-983
        • California Health Care Almanac
        Maternity care in California: delivering the data.
        2016 (Available at:)
        • Gordon SH
        • Sommers BD
        • Wilson IB
        • Trivedi AN
        Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
        Health Aff (Millwood). 2020; 39: 77-84