evaluation of early postoperative hospital discharge after elective caesarean section

ABSTRACT

Caesarean section is one of the most important operations in obstetrics while the postoperative stay in hospital mostly depends on the hospital policy and the presence of complications. To evaluate the effect of early post elective caesarean section discharge within 24 hours, in relation to the indication of the elective caesarean section, intra operative procedures, post operative antibiotics, analgesia and time of starting feeding and mobilization. This is a retrospective review of all elective caesarean sections done in one hospital from the 1[st] of November 2005 to the 31[st] of January 2006 [total 374]. Files were reviewed for intra operative procedure, post operative antibiotics, analgesia, time of starting feeding and mobilization. Any maternal and fetal complication was recorded. The attendant obstetricians were asked for their opinions, disadvantages, complications, mortality, readmission and also for patient inconvenience from this policy of early discharge. The number of elective caesarean section was 374, the mean time between operation and discharge was 20.57 hours. The mean age of the women was 27.8 years, the mean parity was 2.1. The indications for elective caesarean section were previous scar [39.31%], postdate [20.59%], decrease fetal movement [12.57%], abnormal lie [3.48%], breech presentation [4.00%] and on the personal request of the patient [4.00%]. General anesthesia was used in 362 [96.8%] of the patients, while epidural was used only in 12 [3.2%]. Diclofenac was used as postoperative analgesia in 203 [54.3%] of patients, tramadol in 109 [29.1%] and both in 62 [16.6%]. The mean time for starting feeding was 7.23 hours and mobilization in 6.95 hours. The pelvic and parietal peritoneum was sutured [closed] in 284 [75.9%] of patients. One patient stayed in hospital 36 hours for caesarean hysterectomy and was then readmitted for severe infection. Ten patients had minor infection and were treated as outpatients. There was one fetal loss because of respiratory distress syndrome. This study reveals that early post elective caesarean section discharge [less than 24 hours] is safe, regardless of the indication of elective caesarean section, intra operative procedure, post operative analgesia, antibiotics and time of starting feeding and mobility