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      Postpartum quality of life in Indian women after vaginal birth and cesarean section: a pilot study using the EQ-5D-5L descriptive system

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          Abstract

          Background

          There has been little evaluation of the postpartum quality of life (QOL) of women in India and its association with the mode of birth. This study piloted the use of the generic EQ-5D-5L questionnaire to assess postpartum QOL experienced by rural Indian women.

          Methods

          A convenience sample of rural women who gave birth in a health facility in Gujarat or Madhya Pradesh was recruited into this pilot study. QOL was measured during three interviews within 30 days of birth using the EQ-5D-5L questionnaire. Patient-level quality-adjusted life days (QALDs) were estimated. Multivariate regression was used to adjust for selected baseline characteristics.

          Results

          Forty-six women with cesarean section and 178 with vaginal birth from 17 public and private health facilities were studied. Postpartum QOL in both groups improved between interviews 1 and 3. Comparing between vaginal and cesarean births indicated that the vaginal birth group had a higher QOL (0–3 days postpartum: 0.28 vs. 0.57, 3–7 days postpartum: 0.59 vs. 0.81; P < 0.001) and was more likely to report no or slight problems in 4 of 5 health dimensions (mobility, self-care, usual activities, pain or discomfort; P ≤ 0.04) during interviews 1 and 2. Postpartum QOL converged, but still differed between groups by the time of interview 3 (21–30 days postpartum: 0.85 vs. 0.93; P < 0.001). While most women reported no problems by the end of the first postpartum month, the difference in the ability to perform usual activities persisted ( P = 0.001). In result, fewer QALDs were attained by women in the cesarean section group between day 1 and day 21 postpartum (13.1 vs. 16.6 QALDs; P < 0.001). Subgroup analysis showed that having had an episiotomy during vaginal birth was also associated with reduced QOL postpartum, but to a lesser extent than cesarean section. Similar results were obtained when adjusting for socioeconomic, pregnancy and birth characteristics, but postpartum QOL already ceased to be statistically different between groups before interview 3.

          Conclusions

          Vaginal births, even with episiotomy, were associated with a higher postpartum QOL than cesarean births among the Indian women in our pilot study. Finding these expected results suggests that the EQ-5D-5L questionnaire is a suitable instrument to assess postpartum QOL in Indian women.

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          Most cited references21

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          Patient-centered medicine. A professional evolution.

          American medicine is in the midst of a professional evolution driven by a refocusing of medicine's regard for the patient's viewpoint. Historically, medicine has been largely physician centered, but physicians have begun to incorporate patients' perspectives in ways that increasingly matter. Some call this shift "patient-centered" care. In support of the view that this refocusing reflects a broad professional shift, we describe the evolution to patient-centered care in many areas of medicine: patient care, health-related law, medical education, research, and quality assessment.
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            Can The EQ-5D Detect Meaningful Change? A Systematic Review.

            The EQ-5D is one of the most frequently used, generic, preference-based instruments for measuring the health utilities of patients in economic evaluations. It is recommended for health technology assessment by the National Institute for Health and Clinical Excellence. Because the EQ-5D plays such an important role in economic evaluations, useful information on its responsiveness to detect meaningful change in health status is required.
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              Postpartum period: three distinct but continuous phases.

              Postpartum period is distinct in three phases. The third phase is the delayed postpartum period, which can last up to 6 months. Some changes to the genitourinary system are much longer in resolving, and some may never fully revert to the prepregnant state. A burgeoning volume of literature on pelvic floor support implicates childbirth as the initiation of a whole host of conditions including stress urinary incontinence, incontinence of flatus or feces, uterine prolapse, cystocele, and rectocele. The duration and severity of these conditions affect many variables, including the patient's intrinsic collagen support, the size of the infant, the route of delivery, and the degree of perineal trauma occurring either naturally (lacerations) or iatrogenically (episiotomy).
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                Author and article information

                Contributors
                stefan.kohler@uni-heidelberg.de
                kristi.sidney@ki.se
                vishaldiwan@hotmail.com
                lars.lindholm@umu.se
                bharatsarika2005@gmail.com
                kvora@iiphg.org
                ayesha.de.costa@ki.se
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                29 October 2018
                29 October 2018
                2018
                : 18
                : 427
                Affiliations
                [1 ]ISNI 0000 0001 2190 4373, GRID grid.7700.0, Heidelberg Institute of Global Health, Heidelberg University, ; Heidelberg, Germany
                [2 ]ISNI 0000 0004 1937 0626, GRID grid.4714.6, Division of Global Health, Department of Public Health Sciences, , Karolinska Institutet, ; Stockholm, Sweden
                [3 ]ISNI 0000 0004 1802 0819, GRID grid.452649.8, Department of Public Health and Environment, , R. D. Gardi Medical College, ; Ujjain, India
                [4 ]International Centre for Health Research, Ujjain Charitable Trust Hospital and Research Centre, Ujjain, India
                [5 ]ISNI 0000 0001 1034 3451, GRID grid.12650.30, Epidemiology and Global Health, Department of Public Health and Clinical Medicine, , Umeå University, ; Umeå, Sweden
                [6 ]Indian Institute of Public Health, Ahmedabad, India
                Author information
                http://orcid.org/0000-0003-1365-7506
                Article
                2038
                10.1186/s12884-018-2038-0
                6206933
                30373545
                05794547-11d2-4411-9c7c-00d896f680d2
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 2 July 2018
                : 1 October 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100011102, Seventh Framework Programme;
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology
                india,quality of life,postpartum period,vaginal delivery,episiotomy,caesarean section,pilot study

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