This is the current release of the guideline.

• Maternal postpartum morbidity
• Newborn morbidity and mortality

Evaluation
Management
Prevention
Risk Assessment

Obstetrics and Gynecology
Pediatrics

Physicians

To summarize the evidence available with regard to discharge planning for mothers and newborns

Mothers and neonates being discharged from the hospital

Maternal and newborn care after hospital discharge

• Assessment of physical, psychological, and social wellbeing of mother and newborn before discharge
• Follow-up programs in place for postpartum care in the community (e.g., home visits, outpatient breastfeeding clinic, early physician visits)

Maternal and neonatal morbidity and mortality in relation to length of hospital stay

Searches of Electronic Databases

A Medline database search of articles from January 1995 to December 2004, using the key words early postpartum discharge

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Quality of Evidence Assessment*

I: Evidence obtained from at least one properly designed randomized controlled trial.

II-1: Evidence from well-designed controlled trials without randomization.

II-2: Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than one center or research group.

II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results from uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.

III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

*Adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.

Systematic Review

Not stated

Expert Consensus

Not stated

Classification of Recommendations*

1. There is good evidence to recommend the clinical preventive action.
2. There is fair evidence to recommend the clinical preventive action.
3. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.
4. There is fair evidence to recommend against the clinical preventive action.
5. There is good evidence to recommend against the clinical preventive action.

*Adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

This policy statement was approved by the Clinical Practice Obstetrics Committee and the Executive Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC).

The quality of evidence (I-III) and classification of recommendations (A-E) are defined at the end of the "Major Recommendations."

Options for Care after Discharge

1. Early discharge from hospital postnatal increases the risk of neonatal mortality and morbidity. Follow-up programs should take account of this. (II-2 B)
2. The physical, psychological, and social well being of the mother and newborn must be assessed when discharge planning takes place. Primiparous, young, single women are most likely to return to emergency departments with their neonates. (II-2 A)
3. Programs in place for postpartum care in the community are well used and appreciated. Additional programs in the community may decrease neonatal mortality, morbidity, and readmissions. (II-2)

Definitions:

Quality of Evidence Assessment*

I: Evidence obtained from at least one properly designed randomized controlled trial.

II-1: Evidence from well-designed controlled trials without randomization.

II-2: Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than one center or research group.

II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results from uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.

III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Classification of Recommendations**

1. There is good evidence to recommend the clinical preventive action.
2. There is fair evidence to recommend the clinical preventive action.
3. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.
4. There is fair evidence to recommend against the clinical preventive action.
5. There is good evidence to recommend against the clinical preventive action.

*The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on the Periodic Health Exam.

**Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on the Periodic Health Exam.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate postpartum maternal and newborn discharge from the hospital

Not stated

This policy statement reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the Society of Obstetricians and Gynaecologists of Canada (SOGC).

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Safety

Not applicable: The guideline was not adapted from another source.

2007 Apr

Society of Obstetricians and Gynaecologists of Canada - Medical Specialty Society

Society of Obstetricians and Gynaecologists of Canada

Clinical Practice Obstetrics Committee

Principal Authors: Yvonne Cargill, MD, FRCSC, Ottawa ON; Marie-Jocelyne Martel, MD, FRCSC, Saskatoon SK

Committee Members: Catherine Jane MacKinnon, MD, FRCSC, Brantford ON; Marc-Yvon Arsenault, MD, FRCSC, Montreal QC; Elias Bartellas, MD, FRCSC, St John's NL; Sue Daniels, RN, Dartmouth NS; Tom Gleason, MD, FRCSC, Edmonton AB; Stuart Iglesias, MD, Gibsons BC; Michael C. Klein, MD, CCFP, Vancouver BC; Marie-Jocelyne Martel, MD, FRCSC, Saskatoon SK; Ann Roggensack, MD, Kingston ON; Ann Kathleen Wilson, BHSc, RM, Ilderton ON

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on March 10, 2009. The information was verified by the guideline developer on March 25, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.