Maternal outcome following discharge on 2nd versus 3rd day post caesarean section at Mulago Hospital: A randomized clinical trial

Abstract

Background: The number of women delivering by CS has increased worldwide. This is the same as in Mulago hospital where the number has increased greatly over the past five years with the rate ranging from 20 to 25 per year. The available space to admit these patients has not changed hence we end up with the congested postnatal ward with some mothers commonly receiving treatment while on the floor. In some countries discharges from 48 to 72 hours after CS is considered as the standard of care and some have plans to reduce it further to 36 hours as long as mother and baby are stable. Few studies done elsewhere have shown comparable maternal and newborn outcomes between early discharges versus 3rd postoperative day discharges following uncomplicated term delivery. Such a study had not been done at Mulago where there are efforts to identify innovative strategies to decongest postnatal wards without compromising care. Objective: To compare maternal outcome following discharge on day 2 versus day 3 post caesarean section. Method: This was a Randomized controlled clinical trial. Three hundred and thirty eight women who had CS were recruited and randomized in the study. There were 169 women in each arm. Study participants were reviewed on the 7th postoperative day. Maternal outcome was then assessed and compared in both arms. Data was coded and entered into Epi data version 3.1 and exported to STATA version 12.0 for analysis. Primary analysis was by intention to treat. Results: From 15th January to 28th March 2014, 1450 women who had CS were screened of which three hundred and thirty eight were recruited and randomized. There was no statistically significant difference in the rate of wound infection in both arms, 16 (11.3%) of the patients who were discharged on day 2, were found to have wound infection, compared to 7(5.8) of those who were discharged on day 3 postoperatively (RR 2.00; 95% CI 0.87-4.61).There were no statistically significant difference in all the secondary outcomes in both arms. Conclusion: The results showed that maternal outcomes among women discharge on day 2 and day 3 are statistically difference. Recommendation: Carefully selected mothers with uncomplicated caesarean section can be discharge after 48 hours.