Am J Obstet Gynecol 2019 Apr 14. Epub 2019 Apr 14.
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, United States.
This Enhanced Recovery After Surgery (ERAS) Guideline for postoperative care in Cesarean Delivery (CD) will provide best practice, evidenced-based, recommendations for post-operative care with, primarily a maternal focus. The pathway process for scheduled and unscheduled CD, for this ERAS CD guideline, will consider time from completion of cesarean until maternal hospital discharge. The literature search (1966-2017) used Embase and PubMed to search medical subject headings including "Cesarean Section", "Cesarean Delivery", "Cesarean Section Delivery" and all post-operative ERAS® items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Meta-analyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence and recommendations were evaluated according to the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation) as used and described in previous ERAS® Guidelines. The ERAS Cesarean Delivery guideline / pathway has created a pathway for postoperative care). Specifics include sham feeding, nausea and vomiting prevention, post-operative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling.A number of elements of postoperative care of women undergoing cesarean delivery are recommended based on the evidence. As the ERAS Cesarean Delivery pathway (elements / processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.