Safety of Early Postpartum Discharge

A Cochrane review [Abstract] 1 included 17 studies with a total of 9 404 subjects. The studies compared early discharge from hospital of healthy mothers and term infants, of greater than or equal to 2500 grams, with standard care. The definition of early discharge differed across the studies; it was from 6 to 48 hours in 5 studies, less than 60 hours in 1 study, and from 12 to less than 72 hours in 4 studies. Early discharge slightly increased the number of infants readmitted within 28 days for neonatal morbidity (including jaundice, dehydration, infections) (RR 1.59, 95% CI 1.27 to 1.98; 10 trials, n=6918). In the early discharge group, the risk of infant readmission was 69 per 1000 infants compared to 43 per 1000 infants in the standard care group. It is uncertain whether early discharge has any effect on the risk of infant mortality within 28 days. No statistically significant differences in maternal readmissions (RR 1.12, 95% CI 0.82 to 1.54; 11 trials, n=6992) were found. Maternal depression or breastfeeding rates did not differ significantly between the early discharge group and the control group.

A systematic review 2 including 5 RCTs (n=620), ten cohort studies (n=69 978), one case-control study (n=117) and 12 case series reports (n=11 298) was abstracted in DARE. There was moderate evidence of the safety of early (< 48h) discharge for a well-selected population of patients who receive adequate prenatal education and experience normal spontaneous vaginal delivery without complications.

A technology assessment report 3 and a systematic review on early postpartum discharge were abstracted in the Health Technology Assessment Database. The authors could not find evidence on whether or not early discharge may pose a risk to maternal or neonatal health.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, high post randomization exclusions) and by imprecision (few events/ wide confidence intervals), and inconsistency (heterogeneity in direction and size of effec).

References

• Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst Rev 2002;(3):CD002958 [Review content assessed as up-to-date: 30 November 2008]. [PubMed]
• Grullon KE, Grimes DA. The safety of early postpartum discharge: a review and critique. Obstet Gynecol 1997 Nov;90(5):860-5. [PubMed][DARE]
• Conseil d'Evaluation des Technologies de la Santé de Quebec. Evaluations of the risks and benefits of early postpartum discharge - systematic review. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Santé /AETMIS). CETS 97-6 RE, 1997. [DARE]