Postpartum recovery of nulliparous women following scheduled cesarean delivery and spontaneous vaginal delivery: a prospective observational studyAJOG MFM at a Glance

Yusuke Mazda, MD, PhD; Kazuo Ando, MD, PhD; Azusa Kato, MD; Shohei Noguchi, MD, PhD; Takayasu Sugiyama, MD; Kotaro Hizuka, MD, PhD; Azusa Nagai, MD; Yusuke Ikeda, MD; Daisuke Sakamaki, MD; Nan Guo, PhD; Brendan Carvalho, MBBCh, FRCA; Pervez Sultan, MBChB, FRCA, MD (Res)

AJOG Global Reports (Aug 2023)

Postpartum recovery of nulliparous women following scheduled cesarean delivery and spontaneous vaginal delivery: a prospective observational studyAJOG MFM at a Glance

Yusuke Mazda, MD, PhD,
Kazuo Ando, MD, PhD,
Azusa Kato, MD,
Shohei Noguchi, MD, PhD,
Takayasu Sugiyama, MD,
Kotaro Hizuka, MD, PhD,
Azusa Nagai, MD,
Yusuke Ikeda, MD,
Daisuke Sakamaki, MD,
Nan Guo, PhD,
Brendan Carvalho, MBBCh, FRCA,
Pervez Sultan, MBChB, FRCA, MD (Res)

Affiliations

Yusuke Mazda, MD, PhD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki); Corresponding author: Yusuke Mazda, MD, PhD
Kazuo Ando, MD, PhD: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
Azusa Kato, MD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Shohei Noguchi, MD, PhD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Takayasu Sugiyama, MD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Kotaro Hizuka, MD, PhD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Azusa Nagai, MD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Yusuke Ikeda, MD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Daisuke Sakamaki, MD: Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
Nan Guo, PhD: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
Brendan Carvalho, MBBCh, FRCA: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
Pervez Sultan, MBChB, FRCA, MD (Res): Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)

Journal volume & issue: Vol. 3, no. 3
p. 100226

Abstract

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BACKGROUND: Inpatient postpartum recovery trajectories following cesarean delivery and spontaneous vaginal delivery are underexplored. OBJECTIVE: This study primarily aimed to compare recovery following cesarean delivery and spontaneous vaginal delivery in the first postpartum week, and secondarily to evaluate psychometrically the Japanese version of the Obstetric Quality of Recovery-10 scoring tool. STUDY DESIGN: Following institutional review board approval, the EQ-5D-3L (EuroQoL 5-Dimension 3-Level) questionnaire and a Japanese version of the Obstetric Quality of Recovery-10 measure were used to evaluate inpatient postpartum recovery in uncomplicated nulliparous parturients delivering via scheduled cesarean delivery or spontaneous vaginal delivery. RESULTS: A total of 48 and 50 women who delivered via cesarean delivery and spontaneous vaginal delivery, respectively, were recruited. Women delivering via scheduled cesarean delivery experienced significantly worse quality of recovery on days 1 and 2 compared with those who had spontaneous vaginal delivery. Quality of recovery significantly improved daily, plateauing at days 4 and 3 for cesarean delivery and spontaneous vaginal delivery groups, respectively. Compared with cesarean delivery, spontaneous vaginal delivery was associated with prolonged time to analgesia requirement, decreased opioid consumption, reduced antiemetic requirement, and reduced times to liquid/solid intake, ambulation, and discharge. Obstetric Quality of Recovery-10-Japanese is a valid (correlates with the EQ-5D-3L including a global health visual analog scale, gestational age, blood loss, opioid consumption, time until first analgesic request, liquid/solid intake, ambulation, catheter removal, and discharge), reliable (Cronbach alpha=0.88; Spearman–Brown reliability estimate=0.94; and intraclass correlation coefficient=0.89), and clinically feasible (98% 24-hour response rate) measure. CONCLUSION: Inpatient postpartum recovery is significantly better in the first 2 postpartum days following spontaneous vaginal delivery compared with scheduled cesarean delivery. Inpatient recovery is largely achieved within 4 and 3 days following scheduled cesarean delivery and spontaneous vaginal delivery, respectively. Obstetric Quality of Recovery-10-Japanese is a valid, reliable, and feasible measure of inpatient postpartum recovery.

Published in AJOG Global Reports

ISSN: 2666-5778 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Gynecology and obstetrics
Website: https://www.journals.elsevier.com/ajog-global-reports

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