Postnatal maternal re-admission in a district general hospital, England

Abstract

Background: According to the report from The National Maternity and Perinatal Audit (NMPA), the rate of maternal postnatal re-admission is 3.3% across England & Wales, with more women re-admitted after caesarean (4.3%) than vaginal birth (2.9%).
Objective: To identify through an audit reasons for re-admission within 42 days of giving birth and review if the women, who were re-admitted for hypertension management, had a plan for postnatal follow-up at discharge. Secondarily, check the number of women who were reviewed by a consultant within 14 hours.
Methods: The data of all women who were re-admitted between January and December 2022 were studied. The results were analysed and compared with the previous audit.
Results: The number of women re-admitted was 76 out of 3,773 deliveries. The rate of re-admission was 2% (3.3% overall rate in England). Women admitted with raised blood pressure (BP) was 19 (25%). 87% of them had plans made for BP follow-up at discharge. The number of women re-admitted with infections, morbidity was 45/76 (59.2%). 16 were diagnosed with endometritis/ intra-abdominal collection, 4 had urinary tract infection, 5 mastitis, 22 had a wound infection (n=4 episiotomy and n=18 caesarean). Other causes of re-admission were anemia (n=4), all received blood transfusion, post-dural puncture headache (n=2), postoperative abdominal pain (n=2), paralytic ileus (n=1) and Pulmonary Embolus (n=1).
38% of women were reviewed by a consultant within 14 hours. 21 % were not reviewed.
Conclusion: Our audit showed a re-admission rate of 2%. Only 38% were seen within the set target of 14 hours. This can be improved by mentioning these women at the morning and evening handover. We also noted incomplete documentation, hence we emphasized clear documentation.