Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has be...Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scoring assessment was made and there was no significant difference between the two arms of the study. Initiation of successful breastfeeding, and neonatal readmission were similar in both groups. Conclusion: The policy of early discharge can be adopted in low-risk cases scheduled for elective uncomplicated CS provided that the mother and the neonate are in good general condition and proper instructions regarding red flag manifestations are given.展开更多
Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diag...Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.展开更多
Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section.Methods ...Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section.Methods This was a prospective observational cohort study.Patients who underwent elective cesarean section at Xiangya Hospital,Central South University,from October 2022 to December 2022,were categorized into two groups based on the duration of postoperative fasting:the observation group resumed eating after regaining lower extremity muscle strength,while the control group adhered to traditional postoperative fasting guidelines,waiting 6 hours before eating.Primary outcomes included postoperative pain levels assessed by visual analog scale(VAS)pain scores and time to first flatus.Demographic characteristics,time to first lactation,hospital stay length,and patient satisfaction were also assessed.Statistical analysis was conducted using Student’s t test and Chi-squared test,with significance set at P<0.05.Results Out of a total of 300 patients,240 were included in the analysis,comprising 112 in the control group and 128 in the observation group.There were no significant differences in baseline demographic characteristics.The median values of the first flatus time and the first lactation time were 33.37±1.22 vs.18.06±6.34 hours(P=0.003)and 26.34±8.21 vs.7.05±1.26 hours(P=0.001)in the control and observation groups,respectively.The median hospital stay duration in the control and observation groups was 6.54±0.53 vs.4.84±0.18 days(P=0.000),respectively.Median postoperative VAS pain scores and patient satisfaction values were 8.57±0.11 vs.4.91±0.27(P=0.000)and 9.36±0.16 vs.9.72±0.08(P=0.005)in the control and observation groups,respectively.There were no statistically significant differences in other postoperative outcomes,such as intestinal obstruction,infection,and readmission within 42 days(P>0.05).Conclusion Food intake after restoration of lower extremity muscle strength improves first flatus,relieves postoperative pain,shortens hospital stay,and enhances satisfaction after elective cesarean section,without adverse effects.It is crucial for postoperative rehabilitation and should be encouraged.展开更多
目的探讨剖宫产术后早期产后出血相关因素分析及防治对策。方法收集314例剖宫产产妇临床资料进行回顾性研究,其中81例（25.80%）发生产后出血（剖宫产组）,同期选取198例自然分娩产妇为对照组,分析影响剖宫产术后早期产后出血的相关因...目的探讨剖宫产术后早期产后出血相关因素分析及防治对策。方法收集314例剖宫产产妇临床资料进行回顾性研究,其中81例（25.80%）发生产后出血（剖宫产组）,同期选取198例自然分娩产妇为对照组,分析影响剖宫产术后早期产后出血的相关因素。结果剖宫产组出血比例为25.80%,明显高于对照组的5.56%,剖宫产组平均出血量多于对照组,住院时间短于对照组,差异均具有统计学意义（P〈0.05）,剖宫产组中67例（82.72%）出血量介于500~1000 m L,11例（13.58%）出血量介于1000～2000 m L,3例（3.70%）出血量超过2000 m L,差异具有统计学意义（P〈0.05）;单因素分析：宫缩乏力、胎盘因素、子宫裂伤、多次妊娠、妊娠高血压、多胎等组间差异具有统计学意义（P〈0.05）,经过Logistic回归分析,宫缩乏力、胎盘因素、子宫裂伤、妊娠高血压、多胎等因素为剖宫产早期产后出血独立危险因素（P〈0.05）。结论剖宫产术后早期出血可能性高于自然分娩者,并且可能危险因素为宫缩乏力、胎盘因素、子宫裂伤、妊娠高血压、多胎,临床应该根据危险因素采取合适预防出血措施和止血方法。展开更多
文摘Background: Cesarean section is one of the most common surgeries performed worldwide and its consequences and complications represent a major public health concern. The policy of enhanced recovery after surgery has been implemented after cesarean section to optimize perioperative care. Enhanced recovery also aims to reduce the length of hospital stay, which might imply substantial healthcare savings. Rising hospital costs are one of the factors in early discharge. Patients & Methods: This was a prospective cohort study. 158 patients met the inclusion criteria of the study, 81 patients were discharged after 48 hours and 77 patients were discharged after 24 hours. All patients received the same postoperative care and instructions. All the study participants received a phone call 1, 3, and 5 days after discharge to objectively assess the activities of daily living through Katz index of independence in activities of daily living. All patients were offered a postpartum visit 1 week after discharge during which the wound was assessed by the Southampton wound assessment scale. Moreover, other maternal complications such as mastitis, puerperal sepsis, or pyelonephritis were assessed and cases who were readmitted were documented. Initiation of successful breastfeeding and neonatal readmission were reported as well. Results: 158 patients met the inclusion/exclusion criteria of the study. There was no significant difference between the two arms of the study regarding baseline characteristics. Katz index of independence showed that the resumption of activities of daily living after CS was similar in both arms of the study on days 1, 3 and 5 after discharge. Time till the passage of flatus and stool after the cesarean section was significantly shorter among the early discharge arm (9.31 VS 14.68, p value < 0.001 & 13.25 VS 24.82, p value < 0.001 respectively). Maternal readmission was not significantly higher among the early discharge arm and at the 1-week postpartum visit, objective wound assessment by Southampton wound scoring assessment was made and there was no significant difference between the two arms of the study. Initiation of successful breastfeeding, and neonatal readmission were similar in both groups. Conclusion: The policy of early discharge can be adopted in low-risk cases scheduled for elective uncomplicated CS provided that the mother and the neonate are in good general condition and proper instructions regarding red flag manifestations are given.
文摘Objectives: Length of hospital stay after cesarean section is today much shorter than previously, and a stay of only 1 day is used in many departments. However, complications requiring immediate treatment must be diagnosed before leaving hospital. We assessed the time interval from planned cesarean section to diagnosis of major complications in low-risk women to estimate a safe time of discharge. Methods: We performed a retrospective observational study among 5633 women undergoing planned cesarean section from 2001-2017 at Aarhus University Hospital, Denmark. The inclusion criterion was postoperative complication graded as Clavien-Dindo ≥ II. Exclusion criteria were preoperative comorbidity or problems during surgery indicative of need for prolonged stay. Time from cesarean section to suspicion of a postoperative complication was the primary endpoint. Results: The study population consisted of 116 women with unexpected postoperative complications, 47 classified as Clavien-Dindo II and 69 as Clavien-Dindo III-IV. In 63 of the 116, the diagnoses were suspected within 24 hours (Clavien-Dindo II: 25, Clavien-Dindo III-IV: 38). These included all cases of relaparotomy and uterine atony with immediate need of medical treatment. Acute colonic pseudo-obstruction was diagnosed within 2 days, while other complications were suspected and treated 2 to 10 days postoperatively. Conclusions: Among low-risk women with a postoperative complication, all cases requiring relaparotomy and medically treated uterine atony were suspected within 24 hours after surgery. Discharge 24 hours after planned cesarean section seems safe in low-risk patients.
基金from National Natural Science Foundation of China(grant no.82101789)Changsha Natural Science Foundation(grant no.Kq2202369)General project of Hunan Provincial Health Commission(grant no.B202305026242).
文摘Objective To determine the role of regular diet recovery after restoration of normal muscle strength of both lower extremities in promoting postoperative recovery in women undergoing elective cesarean section.Methods This was a prospective observational cohort study.Patients who underwent elective cesarean section at Xiangya Hospital,Central South University,from October 2022 to December 2022,were categorized into two groups based on the duration of postoperative fasting:the observation group resumed eating after regaining lower extremity muscle strength,while the control group adhered to traditional postoperative fasting guidelines,waiting 6 hours before eating.Primary outcomes included postoperative pain levels assessed by visual analog scale(VAS)pain scores and time to first flatus.Demographic characteristics,time to first lactation,hospital stay length,and patient satisfaction were also assessed.Statistical analysis was conducted using Student’s t test and Chi-squared test,with significance set at P<0.05.Results Out of a total of 300 patients,240 were included in the analysis,comprising 112 in the control group and 128 in the observation group.There were no significant differences in baseline demographic characteristics.The median values of the first flatus time and the first lactation time were 33.37±1.22 vs.18.06±6.34 hours(P=0.003)and 26.34±8.21 vs.7.05±1.26 hours(P=0.001)in the control and observation groups,respectively.The median hospital stay duration in the control and observation groups was 6.54±0.53 vs.4.84±0.18 days(P=0.000),respectively.Median postoperative VAS pain scores and patient satisfaction values were 8.57±0.11 vs.4.91±0.27(P=0.000)and 9.36±0.16 vs.9.72±0.08(P=0.005)in the control and observation groups,respectively.There were no statistically significant differences in other postoperative outcomes,such as intestinal obstruction,infection,and readmission within 42 days(P>0.05).Conclusion Food intake after restoration of lower extremity muscle strength improves first flatus,relieves postoperative pain,shortens hospital stay,and enhances satisfaction after elective cesarean section,without adverse effects.It is crucial for postoperative rehabilitation and should be encouraged.
文摘目的探讨剖宫产术后早期产后出血相关因素分析及防治对策。方法收集314例剖宫产产妇临床资料进行回顾性研究,其中81例（25.80%）发生产后出血（剖宫产组）,同期选取198例自然分娩产妇为对照组,分析影响剖宫产术后早期产后出血的相关因素。结果剖宫产组出血比例为25.80%,明显高于对照组的5.56%,剖宫产组平均出血量多于对照组,住院时间短于对照组,差异均具有统计学意义（P〈0.05）,剖宫产组中67例（82.72%）出血量介于500~1000 m L,11例（13.58%）出血量介于1000～2000 m L,3例（3.70%）出血量超过2000 m L,差异具有统计学意义（P〈0.05）;单因素分析：宫缩乏力、胎盘因素、子宫裂伤、多次妊娠、妊娠高血压、多胎等组间差异具有统计学意义（P〈0.05）,经过Logistic回归分析,宫缩乏力、胎盘因素、子宫裂伤、妊娠高血压、多胎等因素为剖宫产早期产后出血独立危险因素（P〈0.05）。结论剖宫产术后早期出血可能性高于自然分娩者,并且可能危险因素为宫缩乏力、胎盘因素、子宫裂伤、妊娠高血压、多胎,临床应该根据危险因素采取合适预防出血措施和止血方法。
