Evaluation of Early Discharge After Cesarean Section
Condition: Early Discharge of Patients After Cesarean Section
Study type: Observational

Summary: 
      The rate of cesarean delivery is increasing, in developing countries, its rate ranges from 13
      to 47% of all cases of delivery. This huge volume of cesarean deliveries has a great
      financial burden on the healthcare system. Rising hospital costs have led to the
      implementation of an early discharge policy after surgeries.
    

Detailed description: 
      Cesarean section (CS) is the most commonly performed surgical procedure worldwide that
      effectively prevents maternal and newborn mortality when used for medically indicated
      reasons. Compared with vaginal delivery, however, the procedure is associated with a higher
      risk of various maternal complications, such as maternal infection and subsequent pregnancy
      complications, and a higher likelihood of re-hospitalization within six weeks of delivery.
      Furthermore, the likelihood of maternal morbidity increases for mothers who repeatedly
      undergo cesarean delivery. CS typically implies a hospital stay for two to three days,
      whereas parous women are often discharged within a few hours after an uncomplicated vaginal
      birth. However, the period after CS includes recovery from surgery as well as adapting to
      motherhood.

      According to World Health Organization, the cesarean section rate will increase to 28.5% of
      total live births by the year 2030. This huge volume of cesarean deliveries and increasing
      cesarean section rate has an incremental burden on the healthcare system, leading to higher
      bed occupancy and financial pressure on the patients and health facilities. Postpartum stay
      at hospitals is steadily declining in the UK and other countries due to cost savings. Rising
      hospital costs are one of the factors in early discharge.

      According to The American College of midwifery and gynecology, earlier discharge is a choice
      if the baby is ready to go home, though, the mother should have basic requirements such as
      normal blood pressure, no symptoms of infection, and adequate pain control. Also, the
      National institute for health and care excellence (NICE) guidelines recommend "women who are
      recovering well, are apyrexial and do not have complications following Caesarean Section
      should be offered early discharge (after 24 hours) from the hospital and follow up at home.
    

Intervention name(s): KATZ index of independence in activities of daily living
Intervention type(s): Other
Intervention description(s): KATZ index measures self-care tasks using a dichotomous rating (dependent-0/independent-1) including; bathing, dressing, toileting, transferring to and from a chair, maintaining continence, and feeding. Six points are considered independent and 0 points are considered fully dependent. Assessment of each patient is made through a phone call at day 1, 3 and 5 after discharge
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Pregnant women admitted to Ain Shams University Maternity Hospital scheduled for elective
        lower-segment cesarean section