The Association of the Mode of Delivery and Maternal Postpartum Readmission: A Systematic Review and Meta-analysis

Background: Postpartum readmission is one of the metrics for assessing the quality of health services. There is inconsistent evidence about postpartum readmission and complications by mode of delivery. Objective: We applied a meta-analysis to investigate whether the mode of delivery is associated with postpartum readmission or complications. Methods: We systematically searched main English databases for studies published up to June 2022. The Newcastle–Ottawa scale (NOS) was used to assess the quality of observational studies. The heterogeneity of included studies was determined using the I2 statistic and Begg’s and Egger’s tests for publication bias, respectively. Results of the random-effects meta-analysis were presented using odds ratio (OR) estimates with 95% confidence intervals (CI). The Stata software version 16 was used for data analysis Results: In total, 18 studies with 514,577 subjects were suitable for reviewing maternal postpartum readmission by mode of delivery. Our findings show that cesarean delivery is a risk factor for increasing postpartum readmission than the vaginal delivery method (overall OR =1.42, CI 95% 1.22, 1.63, I2= 99.7%, p = 0.001). This chance was increased in primary cesarean (OR=2). Postpartum hemorrhage and breast infection did not have risk factors for postpartum readmission. While cardiopulmonary condition, deep vein thrombosis (DVT), genitourinary condition, and wound complication were risk factors among causes. Conclusion: Cesarean delivery is one of the most important risk factors for postpartum readmission, especially both childbirth-related/non-related complications causes. Therefore, it is necessary to revise the schedule of postpartum visits based on the type of delivery.