Enhancing patient mobility following cesarean-delivery – the efficacy of an improved postpartum protocol assessed with pedometers

Abstract

Background The incidence of thromboembolic complications is highest in the immediate postpartum period, especially following caesarean delivery (CD). Ambulation following CD is important in their prevention. We examined the effect of an educational protocol on patients’ mobility following CD, with the use of digital step counters (pedometers). Methods Starting February 2018, we implemented an educational protocol at the maternity ward, which included nurses’ tutoring and subsequent patients’ education, regarding the importance of early ambulation. Following CD, ambulation was initiated 4 h following surgery (as compared to 6 h prior). Scheduled IV acetaminophen was administered at six-hour intervals for 48 h (as compared to only 24 h prior), while additional analgesics were given upon patient request. We compared maternal demographics, delivery and postpartum course between the pre-protocol group (n = 101) and the post-protocol group (n = 100). All patients were asked to wear pedometers for 48 h following the delivery to assess ambulation. Results Patients’ demographics, surgical and post-partum course were non-significant between the groups, except for surgical length (48.5 ± 14.6 vs. 53.5 ± 15.3 min in the pre and post protocol groups, respectively, p = 0.02). The pre-protocol group was treated with more additional analgesics (p = 0.02). A higher number of steps was taken in the post-protocol group as compared to the pre-protocol group (4394 ± 2985 vs.3551 ± 2931, respectively p = 0.04). In a linear regression analysis in which the number of steps served as the dependent variable, this educational protocol was independently associated with a higher number of steps [coefficient 988 steps, 95% CI 137–1838, p = 0.02], as was smoking, after adjustment for surgical length, emergent surgery, maternal age and body mass index. Conclusion An educational protocol which included earlier ambulation and regular interval pain control was associated with improved ambulation following CD.

Hubungan Pengetahuan, Sikap Dan Motivasi Dengan Perilaku Mobilisasi Dini Pada Ibu Post Seksio Sesarea Di RSIA ‘Aisyiyah Samarinda

“…Hal lainnya adalah untuk diperedaran darah menjadi lebih lancar sehingga luka cepat sembuh, otot menjadi kuat dan kondisi ini menjadikan ibu lebih cepat beraktifitas terutama dalam merawat dirinya sendiri dan bayinya (Karlina, 2014). Dipenelitian Herman et al (2020) disebutkan bahwa aktifitas dengan memobilisasi fisiknya secara dini setelah kelahiran dengan SC yakni tromboemboli yag merupakan salah satunya komplikasi dari SC bisa dihindari. Keputusan ibu melakukan imobilisasi secara dini tidak lepas dari pengetahuan yang dimilikinya.…”

Knowledge of Venous Thromboembolism Among Nigerian Pregnant Women: a Preliminary Survey for the 'move for Flow' Program

“…However, other alternative measures have documented evidence of their roles in preventing VTE. Some of these include lifestyle modi cations [22], physical exercises [23,24], inferior vena cava lters [25], pneumatic compression devices [26], and early mobilization following cesarean deliveries [27].…”