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Major postoperative complications in low-risk women after planned caesarean section: Is early discharge safe? A descriptive observational study in Denmark
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  • Anne Kruse,
  • Linn Arendt,
  • Christian Erikstrup,
  • Ulrik Kesmodel,
  • Finn Lauszus,
  • Niels Uldbjerg,
  • Iben Sundtoft,
  • Axel Forman
Anne Kruse
Regional Hospital West Jutland
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Linn Arendt
Regional Hospital Horsens
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Christian Erikstrup
Aarhus University Hospital
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Ulrik Kesmodel
Aalborg University Hospital
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Finn Lauszus
Regional Hospital West Jutland
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Niels Uldbjerg
Aarhus University Hospital
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Iben Sundtoft
Regional Hospital West Jutland
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Axel Forman
Aarhus University Hospital
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Abstract

Objective: To assess the time interval from planned caesarean section to diagnosis of major complications categorised by the Clavien-Dindo classification in low-risk women in order to estimate a safe time of discharge. Design: A descriptive observational study. Setting: Aarhus University Hospital, Denmark. Population: Cohort of women without comorbidity undergoing planned, uncomplicated caesarean section after gestational week 34 who experienced postoperative complications (Clavien-Dindo  II) from 2001 to 2017. Methods: The study population (n=119) was identified from the total population of women undergoing planned caesarean section (n=5,936) as registered in the Aarhus Birth Cohort 2001 to 2012 and subsequently the Aarhus University Hospital database until 2017. Medical records were scrutinised and postoperative complications categorised according to the Clavien-Dindo classification. Main Outcome Measures: Time from planned caesarean section to first clinical suspicion of complications Clavien-Dindo  II. Results: Of the 119 women in the study-population, 49 women were classified Clavien-Dindo II and 70 women Clavien-Dindo III-IV. Sixty women had postoperative bleeding with need of immediate intervention, of which 52 had clinical suspicion of a major complication raised within 24 hours after caesarean section. All women with need of relaparotomy due to bleeding (n=11) were treated within this period. Conclusions: In a low-risk population postoperative bleeding with need of relaparotomy (Clavien-Dindo III-IV) or medical treatment of atonic bleeding (Clavien-Dindo II) are diagnosed within 24 hours after surgery. Our results indicate that discharge after this period is safe in low-risk patients.