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Early discharge from obstetrics-pediatrics at the Hospital de Valme, with domiciliary follow-up
José Antonio Sainz Bueno1, María Ruiz Romano, Rogelio Garrido Teruel
1Obstetric and Gynecology Department, Hospital de Valme, Sevilla, Spain. ginjsb2@wanadoo.es
Insights
Early obstetric discharge (24 hours postpartum) with home follow-up is safe and effective for healthy mothers and newborns. This approach reduces costs by 18-20% and improves maternal satisfaction without increasing complications.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Care
- Public Health
Background:
- Traditional postpartum hospital stays exceed 48 hours.
- Evaluating early discharge programs requires comparing outcomes with standard care.
Purpose of the Study:
- To assess the benefits and drawbacks of early obstetric-pediatric discharge (24 hours postpartum) with home follow-up.
- To compare this program against traditional postpartum hospital stays (over 48 hours).
Main Methods:
- A randomized controlled trial was conducted with healthy mothers and term infants.
- Participants were randomized postpartum, with no prenatal preparation.
- Evaluated variables included rehospitalization, maternal well-being, lactation, satisfaction, and costs.
Main Results:
- No significant differences in maternal or neonatal rehospitalization rates were observed between groups.
- Early discharge did not increase maternal or neonatal disease, fatigue, or anxiety/depression.
- Maternal lactation extended to 3 months in the early discharge group (P=.016).
Conclusions:
- Early obstetric-pediatric discharge is a safe alternative to traditional extended hospital stays.
- The program demonstrates significant cost savings (18-20%) and high maternal satisfaction (>90%).
- Prolonged lactation is a notable benefit of the early discharge model.
Objectives:
This study was undertaken to evaluate the advantages and disadvantages of a program of early obstetric-pediatric discharge (24 hours postpartum) with domiciliary follow-up, compared with the traditional postpartum hospital stay (more than 48 hours), according to the criteria described by reviewers of the subject.
Study Design:
A randomized controlled trial of early obstetric discharge for healthy mothers and term infants, with postpartum randomization, with no prenatal preparation and with observational and clinical follow-up was performed. The participants were mothers with healthy, term neonates (37-42 weeks) weighing more than 2500 g and produced via vaginal delivery and with a verified normal evolution before discharge. The sample consisted of 430 cases (213 cases with early discharge, and 217 control cases) in which the following variables were evaluated: existence of complications in the mother and/or child that required rehospitalization or a medical consultation, existence of maternal problems of fatigue or anxiety/depression after the birth, continuity of lactation and its problems, satisfaction of the mother and family, and relative costs.
Conclusion:
After demonstrating the homogeneity of the groups, no significant differences were found in the rates of maternal rehospitalization (1.9% in the early discharge group vs 2.3% in the control group, relative risk 0.81, 95% CI 0.21-3.03) or in the rates of rehospitalization of the neonates (1.4% in the early discharge group vs 2.3% in the control group, relative risk 0.16, 95% CI 0.15-2.56). No increases were observed in maternal or neonatal disease, puerperal fatigue, or maternal anxiety/depression. A prolongation of maternal lactation to 3 months was observed in the early discharge group (P=.016 <.05 Fisher exact test). When the cost of early discharge is compared with that of traditional discharge with a minimum of 48 hours hospital stay, we find a saving of 18% to 20%. The level of maternal satisfaction with early discharge is better than 90%.
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