[Early post-partum discharge : systematic review of the literature].

BACKGROUND

Hospital stays after vaginal delivery and cesarean birth have shortened over the past 30 years, that practice have contributed to the controversy about the safety of this policy for mother and infants.

OBJECTIVE

To carry out a systematic review of the literature to determine the actual evidence of the effect of early post-partum and post-cesarean discharge on maternal and neonatal readmissions, breast feeding, maternal satisfaction with medical care and post-partum depression.

METHODOLOGY: We included all randomized controlled trials that evaluate different institutional policies evaluating early vs. prolonged length of post-partum hospitalization in low risk patients with vaginal or cesarean delivery, with full-term newborns, weighting more or equal 2,500 g. The methodology of the studies was evaluated with the Cochrane Handbook criteria.

RESULTS

We included five randomized clinical trials, but they have methodological flaws. These include selection bias, limited power and exclusions of patients after randomization. We initially planned to perform a formal meta-analysis of this randomized controlled trials, but the methodological limitations prevent aggregation and quantification in a meta-analysis.

CONCLUSIONS

The existing evidence in randomized controlled trials is insufficient to judge the safety of early post-partum discharge. Published reports concluded showing that this practice is safety, had a limited significance.