Assessing Postpartum Readmission Rates and Associated Risk Factors Using the Robson Classification: A Single-Center Experience

Objective: Postpartum maternal readmission is a significant burden for patients as well as the health system. Postpartum readmission rate is a known factor in evaluating quality of care and in guiding potential beneficial interventions. Use of the Robson Group (RG) classification, initially used for analysis of cesarean section (CS) rates, has been recently expanded to evaluate other obstetrical outcomes. We aimed to describe the rates of postpartum maternal readmission across RG classification and to identify risk factors among the different maternity groups. Study Design: We carried out a retrospective register-based cohort study of all women who delivered >24 weeks gestation at a tertiary medical center over an 18-year period, with classification into the 10 RGs. Rates of postpartum readmission within 42 days of delivery were calculated for each group, as well as indications for readmission. The risk for maternal readmission was analyzed by univariate binary logistic regressions with comparison of results among RC groups, as well as by multivariate analysis models. Results: During the study period, 296,768 deliveries were classified according to Robson Group (RG) classification. The overall readmission rate for the study population was 0.5%. The following groups had a significant risk of readmission: RG 9 (transverse lie), 1.9%; RG 8 (multifetal pregnancies), 1.90=3%; RG 7 (multiparous breech pregnancies) 1.2% and RG2 (nulliparous pregnancies > 37 w, labor induction or prelabor cesarean), 1.2%. The most common indication for readmission among all RGs was fever (61.4%). Conclusions: Postpartum readmission rates varied among the RGs. The highest-risk groups were those with a higher risk of operative delivery, prolonged labor, or malpresentations. Interventions aimed to reduce the number of women in these groups; these included use of external cephalic version, vaginal delivery of breech, and multifetal pregnancies, all of which may be beneficial.