Evaluation of comparative efficacy of modified comprehensive care map mccm for elderly primigravida mothers with caesarean section as against clinical pathway improving maternal and neonatal outcomes

Abstract

newline Abstract newlineBackground: newlineElderly primigravida mothers defined in India as women conceiving for the first time at and#8805;30 years represent a growing high-risk obstetric group due to delayed childbearing influenced by socio-economic, cultural, and professional factors. They are more prone to complications such as pre-eclampsia, gestational diabetes, prolonged labor, and increased cesarean section (CS) rates. Post-CS recovery is often hindered by delayed wound healing, pain, breastfeeding difficulties, and psychological stress, adversely affecting neonatal outcomes. Conventional clinical pathways are largely designed for vaginal deliveries and lack tailored strategies for this group newlineMethodology: newlineA randomized controlled trial was conducted among 164 elderly primigravida mothers undergoing CS, allocated to a control group (n=82, conventional clinical pathway) or an experimental group (n=82, Modified Comprehensive Care Map MCCM). MCCM provided structured, individualized pre-, intra-, and postoperative care, multidisciplinary collaboration, targeted wound and pain management, breastfeeding support, and neonatal monitoring. Outcomes were assessed using the REEDA scale (wound healing), Visual Analogue Scale (VAS) for pain, Edinburgh Postnatal Depression Scale (EPDS), breastfeeding assessment (LATCH), Apgar scores, and neonatal weight gain. newlineResults: newlineThe MCCM group showed superior outcomes: Wound healing: REEDA scores reduced from 6.54 ± 3.45 to 3.45 ± 1.06 vs. 6.70 ± 5.16 to 5.16 ± 1.61 in controls (p lt 0.01). Pain: VAS scores dropped from 4.99 ± 1.23 to 1.52 ± 0.93 vs. 4.91 ± 1.28 to 2.05 ± 1.24 (p = 0.03). Breast engorgement: Grade I improved to 64.6% vs. 41.5%; Grade III reduced to 0% vs. 3.7% (p = 0.005).Postnatal depression: EPDS decreased from 9.98 ± 3.01 to 4.76 ± 2.09 vs. 10.26 ± 2.72 to 6.78 ± 2.81 (p lt 0.01).Neonatal weight gain: 2.693 ± 0.289 kg to 3.704 ± 0.361 kg vs. 2.618 ± 0.273 kg to 3.318 ± 0.382 kg (p lt 0.01). newlineHigher LATCH breastfeeding scores and Apgar scores at 5 minutes were also observed in the