ObjectiveTo determine risks for non‐transfusion severe maternal morbidity and transfusion during a second delivery hospitalisation based on clinical risk factors and obstetric complications from an index, first delivery hospitalisation.DesignRetrospective cohort.PopulationDelivery hospitalisations in the 2010–2017 New York State Inpatient Database.MethodsPatients with a first index delivery hospitalisation followed by a second delivery hospitalisation during the study period were included. Clinical risk factors and obstetric complications were obtained from the first index delivery hospitalisation. Adjusted logistic regression models for non‐transfusion severe maternal morbidity during the second delivery were performed with adjusted (aORs) odds ratios as measures of effect. These analyses were then repeated for the outcome of transfusion.ResultsOf 624 500 paired delivery hospitalisations to 312 250 women, severe maternal morbidity occurred among 0.85% of second deliveries (n = 2672). When adjusted analysis was performed, several clinical factors were associated with severe maternal morbidity in a subsequent pregnancy, including severe maternal morbidity during the index pregnancy (aOR 8.4, 95% CI 7.0, 9.9), transfusion (aOR 2.0, 95% CI 1.6, 2.4) and pregestational diabetes (aOR 2.2, 95% 1.6, 2.9). When analyses were repeated for transfusion, several factors were associated with increased risk, including severe maternal morbidity (aOR 1.5, 95% CI 1.2, 1.8), index transfusion (aOR 6.3, 95% CI 5.6, 7.0), chronic heart disease (aOR 1.6, 95% 1.4, 1.9) and pregestational diabetes (aOR 1.7, 95% 1.3, 2.2).ConclusionMany obstetric complications and chronic conditions identified during an index delivery hospitalisation are associated with severe morbidity during a second, subsequent delivery. Index severe maternal morbidity is associated with the highest odds. These findings may be of use in patient counselling and risk stratification.

中文翻译：

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产妇住院期间严重发病率和输血的复发：一项回顾性队列研究


目的根据首次分娩住院指标的临床危险因素和产科并发症，确定第二次分娩住院期间非输血严重孕产妇发病和输血的风险。设计回顾性队列。2010-2017 年纽约州住院患者数据库中的人口分娩住院情况。方法患者研究期间包括第一次分娩住院治疗和随后的第二次分娩住院治疗。从首次分娩住院期间获得临床危险因素和产科并发症。第二次分娩期间非输血严重孕产妇发病率的调整后逻辑回归模型采用调整后（aOR）比值比作为效果衡量标准。然后对输血结果重复进行这些分析。结果在 624 500 例配对分娩住院的 312 250 名妇女中，第二次分娩的 0.85% 发生严重孕产妇发病率 (n = 2672)。进行调整分析后，一些临床因素与随后妊娠期间的严重孕产妇发病率相关，包括指数妊娠期间的严重孕产妇发病率（aOR 8.4，95% CI 7.0，9.9）、输血（aOR 2.0，95% CI 1.6， 2.4) 和孕前糖尿病 (aOR 2.2, 95% 1.6, 2.9)。当重复输血分析时，发现几个因素与风险增加相关，包括严重的孕产妇发病率（aOR 1.5，95% CI 1.2，1.8）、指数输血（aOR 6.3，95% CI 5.6，7.0）、慢性心脏病（aOR 1.5，95% CI 1.2，1.8）、慢性心脏病（aOR 1.6, 95% 1.4, 1.9) 和孕前糖尿病 (aOR 1.7, 95% 1.3, 2.2)。结论在首次分娩住院期间发现的许多产科并发症和慢性病与随后的第二次分娩期间的严重发病率相关。严重孕产妇发病率指数与最高赔率相关。这些发现可能可用于患者咨询和风险分层。