THE CURRENT STATUS OF POSTOPERATIVE CARE FOR HIGH-RISK WOMEN AFTER CESAREAN SECTION AT THE OBSTETRICS DEPARTMENT, BACH MAI HOSPITAL, VIETNAM, 2024

ABSTRACT

Background: High-risk women after cesarean section are particularly vulnerable to postoperative complications. However, evidence regarding postoperative care practices for this population in low- and middle-income countries remains limited.

Objective: To describe postoperative complications and nursing care practices among high-risk women following cesarean section at a tertiary referral hospital in Vietnam.

Methods: A cross-sectional descriptive study was conducted among 156 high-risk women who underwent cesarean section at the Obstetrics Department of Bach Mai Hospital between March and September 2024. High-risk status was defined based on maternal, obstetric, and postoperative risk factors. Data were extracted from medical records and nursing care forms, including demographic characteristics, clinical risk factors, postoperative complications, and care activities. Descriptive statistics were used for data analysis.

Results: The mean maternal age was 32.8 ± 4.6 years, with 34.0% of women aged ≥35 years. Common risk factors included previous cesarean section (46.2%), hypertensive disorders of pregnancy (28.8%), and gestational diabetes mellitus (21.2%). Postpartum anemia (23.7%), surgical site infection (12.8%), and postpartum hemorrhage (9.6%) were the most frequent postoperative complications. Most women received adequate vital sign monitoring (94.2%) and surgical wound care (89.1%). However, psychological support was less consistently provided, with only 76.9% of women receiving counseling.

Conclusions: High-risk women after cesarean section experience substantial postoperative morbidity. Although adherence to essential postoperative care practices was generally high, gaps remain in psychological support and comprehensive care. Strengthening holistic postoperative care may improve maternal outcomes in tertiary hospital settings.

Keywords: High-risk women; cesarean section; postpartum care; nursing care; Vietnam.

1. INTRODUCTION

Cesarean section is one of the most frequently performed obstetric procedures worldwide, particularly in tertiary referral hospitals. Although cesarean delivery is often a life-saving intervention, it is associated with a higher risk of maternal morbidity compared with vaginal delivery, especially among women with underlying medical conditions, pregnancy-related complications, or complex obstetric histories.

High-risk women after cesarean section are more susceptible to adverse outcomes such as postpartum hemorrhage, surgical site infection, thromboembolic events, delayed physical recovery, and postpartum psychological disorders. These risks necessitate comprehensive and closely monitored postoperative care. However, in many low- and middle-income countries, including Vietnam, evidence on postoperative care practices for high-risk women remains scarce.

Bach Mai Hospital is a major tertiary referral hospital in northern Vietnam, where an increasing number of high-risk cesarean deliveries are managed each year. Evaluating the current status of postoperative care for this vulnerable population is essential for identifying gaps and improving the quality of maternal health services.

2. METHODS

2.1. Study design and setting

This cross-sectional descriptive study was conducted at the Obstetrics Department of Bach Mai Hospital, a tertiary referral hospital in Hanoi, Vietnam.

2.2. Study population and sample size

The study included 156 women who underwent cesarean section and were classified as high-risk during the postpartum period. Participants were selected consecutively from March to September 2024.

2.3. Definition of high-risk women after cesarean section

Women were classified as high-risk if they met at least one of the following criteria:

Maternal-related factors:

• Maternal age ≥35 years
• Pre-existing medical conditions (e.g., hypertension, diabetes mellitus, cardiovascular disease)
• History of preeclampsia or eclampsia
• Antenatal anemia

Obstetric-related factors:

• Previous cesarean section (one or more)
• Placenta previa or placenta accreta spectrum
• Macrosomia or multiple pregnancy
• Emergency cesarean section

Postoperative-related factors:

• Postpartum hemorrhage
• Surgical site infection
• Coagulation disorders
• Postpartum anemia

2.4. Data collection

Data were collected retrospectively from medical records and nursing care forms. Variables included demographic characteristics, obstetric and medical risk factors, postoperative complications, and postoperative care activities such as vital sign monitoring, wound care, early mobilization, nutritional counseling, and psychological support.

2.5. Data analysis

Data were analyzed using descriptive statistics. Categorical variables were presented as frequencies and percentages, while continuous variables were expressed as means and standard deviations.

2.6. Ethical considerations

This study was approved by the Institutional Review Board of Bach Mai Hospital. All data were anonymized prior to analysis. Informed consent was waived due to the retrospective nature of the study.

3. RESULTS

3.1. General characteristics of participants

Table 1. Distribution of participants by age group (n = 156)

The mean maternal age was 32.8 ± 4.6 years.

3.2. Distribution of risk factors

Table 2. Common risk factors among participants

3.3. Postoperative complications

Table 3. Post-cesarean complications

3.4. Status of postoperative care

Table 4. Postoperative care activities for high-risk women

4. DISCUSSION

This study provides a comprehensive overview of postoperative care for high-risk women after cesarean section at a tertiary referral hospital in Vietnam. The findings reveal a high prevalence of obstetric and medical risk factors, a considerable burden of postoperative complications, and generally good adherence to essential postoperative care practices, although notable gaps remain.

More than one-third of participants were aged 35 years or older. Advanced maternal age has been widely recognized as a significant risk factor for adverse maternal outcomes following cesarean delivery, including postpartum hemorrhage, infection, and delayed recovery. The age distribution observed in this study is comparable to reports from other tertiary hospitals, where women aged ≥35 years account for approximately 30–40% of high-risk cesarean deliveries.

Nearly half of the women had a history of previous cesarean section, reflecting the increasing trend of repeat cesarean deliveries. Previous cesarean section is associated with a higher risk of abnormal placentation, uterine atony, and postoperative infection, further emphasizing its role as a key determinant of high-risk status.

Hypertensive disorders of pregnancy and gestational diabetes mellitus were common among participants. These conditions may impair wound healing and increase susceptibility to infection and hemorrhage. Antenatal anemia, present in nearly one-fifth of participants, likely contributed to the high rate of postpartum anemia observed.

Adherence to core postoperative care practices, including vital sign monitoring and wound care, was high, reflecting the standardized protocols and clinical expertise available at a tertiary hospital. However, psychological support was less consistently implemented, highlighting a gap in holistic postpartum care.

5. LIMITATIONS OF THE STUDY

Several limitations should be acknowledged. First, the cross-sectional design precludes causal inference between risk factors, care practices, and outcomes. Second, the single-center setting may limit generalizability to other healthcare levels. Third, retrospective data collection relied on the completeness of medical records, potentially underestimating undocumented care activities. Fourth, psychological outcomes were not assessed using validated instruments. Finally, post-discharge outcomes were not evaluated.

Despite these limitations, the study provides valuable real-world evidence on postoperative care for high-risk women in a tertiary hospital in a low- and middle-income country.

6. CONCLUSIONS

High-risk women after cesarean section at Bach Mai Hospital experience substantial postoperative morbidity. Although essential postoperative care practices were largely implemented, gaps remain in comprehensive and psychological care. Strengthening holistic postoperative care may improve maternal health outcomes.

7. RECOMMENDATIONS

• Develop standardized postoperative care protocols specifically for high-risk women.
• Enhance training for nurses and midwives in psychological assessment and counseling.
• Promote multidisciplinary collaboration to improve comprehensive postpartum care.

REFERENCES

1. World Health Organization. WHO recommendations on maternal and newborn care. Geneva; 2018.
2. American College of Obstetricians and Gynecologists. Postpartum care guidelines. ACOG; 2020.
3. National Institute for Health and Care Excellence. Postnatal care. NICE; 2021.
4. Betrán AP, et al. The increasing trend in cesarean section rates worldwide. PLOS ONE. 2016.
5. Souza JP, et al. Maternal complications associated with cesarean delivery. BMC Pregnancy and Childbirth. 2019.

Hà Thị Bích, MSc (Nursing) - Department of Obstetrics, Bach Mai Hospital, Hanoi, Vietnam

Phạm Thị Thu Thuỷ, MSc (Nursing) - Department of Obstetrics, Bach Mai Hospital, Hanoi, Vietnam

Hoàng Phương Anh*, BSc (Nursing) - Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam

*Corresponding author: hoangphuonganh@hmu.edu.vn