Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Hypertension

Poster Session 3

(689) Maternal morbidity in postpartum severe preeclampsia by obstetric hospital volume

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective: Preeclampsia is a leading cause of maternal morbidity and mortality in the US. We investigated the relationship between facility delivery volume and rates of non-transfusion severe maternal morbidity (SMM) among patients readmitted postpartum for severe preeclampsia (SPREX).

Study Design: Retrospective cohort study using the Nationwide Readmissions Database (2015-2020), among patients readmitted for SPREX. Our primary outcome was non-transfusion SMM during readmission, defined per US Centers for Disease Control and Prevention criteria. We also evaluated SMM, cardiac SMM and individual morbidities. The exposure variable was the number of annual deliveries at the readmitting facility. Restricted cubic splines with 4 knots were used to assess the functional form of the relationship between obstetric volume and non-transfusion SMM; a linear relationship was identified as optimal. Logistic regression was used to generate adjusted odds ratios (aOR) which controlled for maternal age, non-transfusion SMM at delivery, expanded obstetric comorbidity index, and hypertensive disorder of pregnancy (HDP) during delivery.

Results: The cohort included 29,472 patients readmitted postpartum with SPREX, of which the primary payer was 54.9% private and 41.7% governmental. Median age was 31.4 years. Most patients did not have prior HDP (64.7%) or chronic hypertension (85.6%). Non-transfusion SMM occurred in 7.3% readmitted to hospitals with >2,000 deliveries compared to 8.5% with 1-2,000 deliveries, and 51.9% without any delivery hospitalizations (Panel 1). The most common SMM was pulmonary edema and heart failure (Panel 2). For every increase in 1,000 deliveries, the odds of a non-transfusion SMM at readmission decreased by 3.5% (aOR: 0.965; 95% confidence interval: 0.94, 0.99).

Conclusion: Non-transfusion SMM for postpartum readmissions with SPREX features were inversely associated with obstetric hospital volume. This information may guide risk-reducing initiatives for identifying strategies to optimize postpartum care at facilities with lower or no delivery volume.