Postpartum discharge of normal vaginal deliveries and its impact on the obstetric bed-state in the main general hospital in the Maltese Islands

摘要

The most effective and immediate measure to free beds in the Obstetric wards is an efficient postpartum discharge of normal vaginal deliveries. Normal vaginal deliveries comprise more than 60% of women delivered at Mater Dei Hospital. An extensive literature review suggests postpartum discharge can be broadly divided in three categories. Very early discharge (6-24 hours postpartum), early discharge (24-48 hours), and late discharge 48+ hours. Very early and early postpartum discharge has positive effects on maternal health and satisfaction. Very early and early discharged mothers are less prone to puerperal depression, ingest less sedatives, score high on satisfaction, and persist in breastfeeding. On the contrary, very early postpartum discharge (12-24 hours postpartum) has been associated with more neonatal readmissions and adverse events affecting the newborn. Moreover neonatal adverse events also seem to occur when postpartum discharged occurred within 30 hours of delivery. Discharge beyond 36-48 hours since delivery appears the safest and most beneficial time interval for both maternal and neonatal health. Conclusion: Discharge following uncomplicated normal vaginal deliveries at 36-48 hours may achieve an average gain of 12 hours bed-stay for each Obstetric bed at Mater Dei Hospital. To achieve this goal, post-partum discharge following uncomplicated normal vaginal deliveries should occur from 8.00 am to 10.00 pm. If this discharge policy is adhered to, the Obstetric bed-stay would gain 21-25% of beds following normal vaginal deliveries which translates to a net of five to six Obstetric beds daily.