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.