Is Uncomplicated Caesarean Delivery Safer Following the Ultra-short Stay Post-operative Management Protocol than the Traditional Protocol? A randomized Controlled Trial
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Methods: This was a randomized controlled trial conducted in 3 centres in Bayelsa state, Southsouth Nigeria. Federal Medical Centre, Yenagoa; Niger Delta University Teaching Hospital, Okolobiri, and Diete-Koki Memorial Hospital, Opolo with 179 women who just had uncomplicated Caesarean delivery were randomized into ultra-short stay(90) and traditional groups(89). The ultrashort stay group had minty chewing gums for 2 hours after surgery, started ambulating and taking orally from 6 hours(regular diet from 12 hours); and urethral catheter discontinued 6-12 hours postoperative. The traditional group commenced ambulation 12-24 hours, oral intake initiated and urethral catheter discontinued at 24 hours post-operative. In the ultra-short stay group, wounds were exposed and patient discharged at 36-48 hours post-operative. In the traditional group, patient was discharged on day 3-5. Both groups were counselled on wound care at discharge. Safety outcomes were recorded during the postnatal visits.
Results: There was no difference in occurrence of spinal headache(X2 <0.01,p=0.977), wound sepsis(X2 <0.01,p=0.983), and puerperal sepsis(X2 =2.05,p=0.153) between the 2 groups, but a higher rate of readmission in the traditional than the ultra-short stay group(X2 =4.14,p=0.042). There was no maternal mortality.
Conclusion: Safety (spinal headache, wound sepsis, puerperal sepsis) after uncomplicated Caesarean, is the same in the ultra-short stay and the traditional protocol, which has a higher readmission rate. The ultra-short stay post-operative management protocol is therefore recommended after uncomplicated Caesarean section.
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