Sainz Bueno José Antonio, Romano María Ruiz, Teruel Rogelio Garrido, Benjumea Antonio Gutiérrez, Palacín Ana Fernández, González Carmen Almeida, Manzano Manuel Caballero
Obstetric and Gynecology Department, Hospital de Valme, Sevilla, Spain.
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 1):714-26. doi: 10.1016/j.ajog.2005.01.015.
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.
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.
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%.
根据该主题评审人员描述的标准，本研究旨在评估早期产科 - 儿科出院（产后24小时）并进行家庭随访的方案与传统产后住院（超过48小时）相比的优缺点。
对健康母亲和足月儿进行早期产科出院的随机对照试验，产后随机分组，无产前准备，进行观察和临床随访。参与者为有健康足月儿（37 - 42周）、体重超过2500克、经阴道分娩且出院前证实病情进展正常的母亲。样本包括430例（213例早期出院，217例对照），评估了以下变量：母亲和/或孩子出现需要再次住院或就医咨询的并发症情况、产后母亲疲劳或焦虑/抑郁问题的存在情况、泌乳的连续性及其问题、母亲和家庭的满意度以及相对成本。
在证明两组具有同质性后，发现母亲再次住院率（早期出院组为1.9%，对照组为2.3%，相对风险0.81，95%可信区间0.21 - 3.03）或新生儿再次住院率（早期出院组为1.4%，对照组为2.3%，相对风险0.16，95%可信区间0.15 - 2.56）无显著差异。未观察到母亲或新生儿疾病、产褥期疲劳或母亲焦虑/抑郁增加。早期出院组母亲泌乳期延长至3个月（P = 0.016 < 0.05，Fisher精确检验）。当将早期出院的成本与传统的至少48小时住院出院的成本进行比较时，我们发现节省了18%至20%。母亲对早期出院的满意度水平超过90%。
