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Table 1 Characteristics of included studies

From: Vaginal delivery: how does early hospital discharge affect mother and child outcomes? A systematic literature review

Study Design Inclusion criteria Intervention (n) Control (n) Age Findings
Carty 1990 [29], Canada RCT Vaginal birth, prenatal classes attendance, stable relationship with partners Group 1: discharge from 12 h to 24 h + nurse home visit on days 1, 2, 3, 5 and 10 (44) Group 2: discharge from 25 h to 48 h + nurse home visit on days 3, 5 and 10 (49) Group 3: discharge at 4 days + nurse home visit on 10 (38) Mean (SD) 30.24 (3.80) Maternal outcomes ▪ Morbidity Problems requiring physician referral in the first 10 days postpartum Intervention: 5/93 (urinary tract infection, episiotomy infection, mastitis, subinvolution) Control: 3/38 (endometritis, episiotomy, subinvolution) ▪ Hospitalization within the firstmonth Intervention: 1/93 (urinary tract infection) Control: 1/38 (endometritis) ▪ Psychological functioning Depressive affect at 1 month (Beck Depression Index) Significant difference between group 2 and group 3 in favour of group 2 (p < 0.05) Confidence (subscale of a questionnaire for women during their childbearing years) At 1 week: score in favour of group 1 in comparison with group 3 (p < 0.03), no significant difference between group 1 and 2 At 1 month: no difference between groups Neonatal outcomes ▪ Morbidity Problems requiring physician referral in the first 10 days postpartum Intervention: 4.3% (hyperbilirubinemia and cord infection,) Control: 2.6% (ABO incompatibility and diaper rash) Breastfeeding duration Intervention: 87% Control: 79% Length of stay: mean in days (SD) Group 1: 1.12 (0.40) Group 2: 2.06 (0.56) Group 3: 4.03 (0.69)
Gagnon 1997 [36], Canada RCT Parity 0 to 4, normal pregnancy, ability to speak English, French or Spanish, telephone availability, residence within 30 min of hospital Discharge between 6 to 36 h, nursing care by telephone within 48 h and at 10 days, home visit at days 3 and 5 postpartum. Prenatal preparation: home visit at 34 and 38 weeks’ gestation (80) Discharge between 48 to 72 h, and follow-up as determined by woman’s and infant’s physicians (100) Mean (SD) 29.6 (4.7) vs 29.1 (5.3) Respectively int. and control Maternal outcomes ▪ Competence in mothering Perceived Maternal Task Performance Scale Mean difference (95% CI) at 1 month: 4.3 (−7.7–16.3) Neonatal outcomes ▪ Infant health contacts For feeding, crying, sleeping or care of the umbilical cord RR (95% CI): 0.88 (0.45–1.73) ▪ Infant weight gain Mean difference (95% CI) during the follow-up period 1.2 (−2.8–5.2) ▪ Neonatal hyperbilirubinemia RR (95% CI) 0,50 (0.10–2.50) Breastfeeding (predominantly at 1 month) Intervention: 55.1% Control: 39.2% RR (95% CI): 1.41 (1.02–1.94), ns when adjustment in those to breast-feed at baseline Length of stay: mean in hours (SD) Intervention: 37.5 (19.7) Control: 54.3 (18.0)
Hellman 1962 [30], USA RCT NR Discharge within 48 h or between 49 and 72 h + midwife home visits within 48 h of discharge, within first week and sometime at 3 weeks (1941) Discharge after 5 days + midwife home visits within first week and sometime at 3 weeks (316) Mean 23.6 vs 23.8 Respectively int. and control Maternal outcomes ▪ Re-admission atweeks Intervention 1.8% Control 0.6%, ns ▪ Complication rate Significant difference in febrility, lochia, involution of the uterus and breast engorgement in favour of control group ▪ Need for advice rate Significant difference between groups For mother Intervention 72.6% vs control 63.0% For newborn Intervention 72.5% vs control 62.8% Neonatal outcomes ▪ Re-admission rate atweeks Intervention 1.1% vs control 0.6%, ns ▪ Mortality Intervention 0.46% (aspiration of milk, massive bronchopneumonia, unknown reason) vs control 0.24% (heart-disease), ns ▪ Weight gain Results reported in graph (no significant difference) ▪ Complication rate (Morbidity) Intervention 35.1% Control 32.1%, ns Breastfeeding ▪ Rate atweeks Intervention 15% control 6% ▪ Breast engorgement Results reported in graph
Sainz-Bueno 2005 [31], Spain RCT Healthy term neonates (34/42 weeks), weigh >2500 g, vaginal delivery with normal evolution Discharge in the first 24 h with qualified nurse visits over the next 24 to 48 h, monitored at 7 to 10 days in practice, telephone consultation at 1, 3 and 6 months.No prenatal preparation (213) Discharge after minimum 48 h, monitored at 7 to 10 days in practice, telephone consultation at 1, 3 and 6 months (217) ≤ 30 y. 53.9% Maternal outcomes ▪ Readmission withinweeks RR (95% CI) = 0.81 (0.21–3.03) ▪ Maternal consultation RR (95% CI) = 0.78 (0.30–2.10) ▪ Morbidity RR (95% CI) = 0.73 (0.30–2.20) ▪ Depression At 1 week RR (95% CI) = 0.64 (0.25–1.63) At 1 month RR (95% CI) = 0.30 (0.33–3.20) ▪ Fatigue At 1 week RR (95% CI) = 0.85 (0.43–1.64) At 1 month RR (95% CI) = 0.50 (0.04–5.54) Neonatal outcomes readmission within 28 days RR (95% CI) = 0.61 (0.15–2.56) Breastfeeding At 1 week RR (95% CI) = 0.48 (0.14–1.65) At 1 month RR (95% CI) = 0.58 (0.25–1.36) At 3 months RR (95% CI) = 0.62 (0.42–0.91), p = 0.16 At 6 months RR (95% CI) = 0.68 (0.46–1.0006) At > 9 months RR (95% CI) = 0.81 (0.49–1.32) Evaluation of costs Saving of 18.1% by an early discharge program with 1 home visit and telephone follow-up
Smith-Hanrahan 1995 [34], Canada RCT English or French speaking, social support at least 12 h/days during 2 frist days, no major obstetrical complications, no prolonged mother-infant separation in hospital, healthy newborn infant with a wiegth between 2500 and 4500 g. feeding established. Length of stay <60 h, nursing follow-up by phone call starting within 24 h after discharge with home visit in case of need, phone number available 24 h/24 and 7d/7, paediatric and obtretric office visits (35) Length of stay ≥60 h, paediatric and obtretric office visits (46) Mean (SD) 29.5 (4.5) vs 29.3 (4.6) Respectively int. and control Maternal outcomes ▪ Re-admission atweeks Intervention 0/35 Control 0/46, ns Neonatal outcomes ▪ Re-admission atweeks Intervention 0/35 Control 0/46, ns Breastfeeding ▪ Proportion of breastfed neonates atweeks Intervention 17/35 Control 29/46, ns
Waldenström 1987 [35], Sweden RCT No significant complication during pregnancy and birth, no significant morbidity in first 24 h for both mother and newborn, gestational age > 37 weeks, birthweight ≥3000 g, Apgar score at 5 min ≥ 7 Discharge between 24 and 48 h, prenatal nurse home visit 4 weeks before term, daily nurse home visit for 3 to 4 days post discharge, paediatric office visit on day 5 Discharge >48 h, standard hospital care without home visit after discharge Early discharge 28 years vs late discharge 27 years Maternal outcomes ▪ Re-admission atweeks Intervention 0/50 Control 1/54, ns ▪ Depressed mood in firstweeks Intervention 3/50 Control 4/54, ns Neonatal outcomes ▪ Re-admission atweeks Intervention 1/50 Control 0/54, ns Breastfeeding ▪ Proportion of breastfed neonates atmonths Intervention 37/49 Control 45/52, ns ▪ Proportion of breastfed neonates atmonths Intervention 28/49 Control 20/52, ns
Yanover 1976 [32], USA RCT Parity 0 or 1, 19y < mother age < 35 y low medical risk, ≥ 12th-grade education, father’s attending prenatal preparation, communicate well in English, parents residing together within 32 km of hospital. Antenatal preparation for child birth, early discharge, father participation. Infant in nursery for 6 h, Release from hospital as soon as the mother and infant (if fulfilled discharge criteria at 12 h). Daily home visits until day 4 postpartum (44) Antenatal preparation for child birth. Infant in nursery for 24 h, discharge ≥48 h, paediatric visit at 2 weeks, obstetric visit at 6 weeks (44) NR Maternal outcomes ▪ Morbidity No difference in frequency and types of morbidity within the first 6 weeks (obstetrical laceration, post-partum infection, postpartum haemorrhage) ▪ Re-admission atweeks Intervention 0% Control 0%, ns Neonatal outcomes ▪ Morbidity No difference in frequency and types of morbidity (need for hospital care: in each group 2 newborns for jaundice, 2 newborn in control group for pneumonia) Evaluation of costs Saving about 30% of daily costs for early discharge Length of stay: median in hours (range) Early discharge: 26 (12–86) Conventional stay: 68 (31–167)