Advantages and disadvantages of early oral hydration over intravenous hydration in post cesarean delivery.

Thesis Report.

ABSTRACT: This study was conducted in Maternity Hospital Thapathali Kathmandu Nepal from 2059/03/10 to 2059/04/18.The overall objective of this study was to find out the advantages and disadvantages of early oral hydration over intravenous fluid therapy in cesarean delivery cases. The parameters studied were time of ambulation, time of demand of nest fluid, initiation of breast-feeding without support, nausea and vomiting & abdominal distension. It is a prospective hospital based comparative study. Total cases enrolled were 100(50 in each group. All cases of cesarean section under general anaesthesia were enrolled from the operation theatre. Cases with history of medical illness in pregnancy, obstetric complications like severe PET (preeclamptic toxaemia), eclampsia, prolong second stage of labour, obstructed labour, antepartum hemorrhage (APH), post partum hemorrhage (PPH), multiple pregnancies and patient of blood transfusion were excluded. The enrolled cases had clinical examination, measurement of abdominal girth initially after operation then 12 hourly for 24 hours, time of ambulation, time of breast feeding without support were recorded, any complaint of nausea, vomiting and abdominal distension were also noted, In the study cases early oral fluid was started with sips of water when she was fully awoke and then time of nest demand of fluid and its time also noted. Alternatives cases were left to have I/V fluid for 24 hours. Early ambulation was noted in the study group in 64% of cases whereas only 16% of cases were found in the control group, which is statistically significant (p<0.005). The mean time of starting of the oral fluid was 116.9 minutes of operation (minimum 55 minutes maximum 180 minutes) and the mean time for demand of next fluid was 57 minutes, SD was +_ 35.34. The mean time for breastfeeding was 16.85 hours and SD +_ 15.77 where as 14.92 hours and _+ 9.77 in study group and control group respectively, which was statistically not significant (p>0.5). The mean intake of fluid was 2206.60ml SD +_ 285.16 and 2931.00ml and SD _+ 395.11 in study and control group respectively which was statistically significant (p.0.005). Similarly mean output was 1346.60ml, SD+_ 326.99 in study group and 1526.40 ml (mean), _+4187.719SD) in control group, which was statistically not significant (p>0.05). there were no cases of nausea and vomiting noticed I both groups during period of study. In the study group there was abdominal distension in one case but not in the control group. The mean abdominal girth change was 2.04cm SD+_1.09 & 1.20cm & +_ 95 in study and control group respectively, which was statistically significant (p<0.005). So the study concluded that early ambulation that help to minimize the postoperative complication have been found in two third patients of the study group and one-sixth patients in the control group. There was no significant difference found in the time of breast-feeding. Increased abdominal girths were found more in the study group than in the control group that was also significant statistically.

Eng.