Physical Activity After a Normal Spontaneous or Cesarean Delivery
Condition: Postpartum Disorder
MeSH terms: Puerperal Disorders
Study type: Interventional

Summary: 
      To the best of the investigators knowledge the average level of physical activity (PA) of
      parturients recovering from a cesarean delivery or after a normal spontaneous vaginal
      delivery (NSVD) remains unknown. Taking in consideration that parturients are in a
      hypercoagulable state and that obstetric venous thromboembolism (VT) is one of the most
      common causes of maternal morbidity and mortality, ambulation is of utmost importance to
      anesthesiologists as well as obstetricians. In order to promote mobility, first the
      investigators need to learn the average parturients level of physical activity in the
      immediate post-partum period and up to 48 hours after delivery. This information may help us
      promote mobility in the immediate postpartum period, particularly for those that underwent a
      cesarean delivery since they are at higher risk of VT.
    

Detailed description: 
      Cesarean delivery is the most common surgery performed in the United States. Despite this
      fact, there is a paucity of literature looking into the implementation of enhanced recovery
      after surgery (ERAS) for patients undergoing this type of surgery. ERAS protocols have shown
      to improve recovery from surgery, decreasing complication and hospital length of stay. The
      pathway for enhanced recovery targets improving 3 factors that have been associated with
      increased hospital length of stay and complications. These factors are pain, immobilization
      and postoperative ileus. These factors, many times are inter-related. A patient in pain would
      tend not to ambulate as this may exacerbate the pain and discomfort. In order to alleviate
      pain, the patient would most likely receive an opioid for pain management and these
      medications are known to have undesirable side effects such as nausea, vomiting, sedation,
      respiratory depression, constipation and urinary retention. All of these adverse effects
      (AEs) may lead to complications or increased hospital length of stay.

      To the best of the investigators knowledge the average level of physical activity (PA) of
      parturients recovering from a cesarean delivery or after a normal spontaneous vaginal
      delivery (NSVD) remains unknown. Taking in consideration that parturients are in a
      hypercoagulable state and that obstetric venous thromboembolism (VT) is one of the most
      common causes of maternal morbidity and mortality, ambulation is of utmost importance to
      anesthesiologists as well as obstetricians. In order to promote mobility, first we need to
      learn the average parturients level of physical acuity in the immediate post-partum period
      and up to 48 hours after delivery. This information may help us promote mobility in the
      immediate postpartum period, particularly for those that underwent a cesarean delivery since
      they are at higher risk of VT.

      Given the lack of knowledge regarding the physical activity level of parturients in the
      postpartum period, the investigators have designed a pilot study to objectively measure their
      PA. Patients having a normal spontaneous vaginal delivery will serve as our control group.
      These patients are going through the same physiologic changes that their counterparts (CD
      patients) are going through, the only difference being the stress of surgery in the CD
      group.The use of Fitness trackers (i.e Fitbit(R), Actigraph GT3X +) has been used to measure
      and promote physical activity in a cardiac rehabilitation population, as well as in
      parturients self-identified as inactive. The investigators intend to use the Actigraph GT3X+
      to measure the level of physical activity of 50 parturients (25 NSVD and 25 post CD). The
      information obtained, will help us tailor the anesthetic/analgesic management of parturients
      in such a way that promotes early ambulation and recovery. The investigators estimate that we
      need approximately a total of 50 patients, 25 per group to assess if there is a difference in
      the level of PA between parturients after a NSVD or CD. We will aim to recruit 60 patients 30
      per group to account for missing data, protocol violations, equipment malfunction or patients
      drop outs.This will be a pilot, prospective study aimed at measuring the physical activity
      (PA) of American Society of Anesthesiologists (ASA) Classification I and II women aged 18
      years and older, after a normal spontaneous vaginal (NSVD) or cesarean delivery (CD).
      Subjects will be ASA I and II women aged 18 years and older, knowing to have had either a
      NSVD or CD (under neuraxial anesthesia). After delivery, and assuring that mother and baby
      are stable, patients will be approached by a member of the study team to discuss the study
      and obtain informed consent. After obtaining informed consent, patients will be divided into
      Two (2) groups depending on the mode of delivery. Group 1 will be NSVD and group 2 will be CD
      patients. Patients will be provided with a fitbit- based Actigraph GT3X + hardware, 3 hours
      after delivery. Patients will be evaluated every 12 hours after delivery for a period of 48
      hours. During these evaluation points, pain (visual analogue scores), factors affecting
      mobility, and level of satisfaction with their analgesia will be assessed. After 48 hours the
      Actigraph GT3X + will be interrogated and objective data, such as mean daily steps, will be
      obtained using the aforementioned software.
    

Intervention name(s): Actigraph
Intervention type(s): Behavioral
Intervention description(s): following delivery a ActiGraph will be offered to patients to track their steps
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention