Improving maternal and neonatal outcomes through enhanced recovery after caesarean approach: a systematic review
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252414Keywords:
Enhanced recovery, Caesarean section, Traditional technique, Protocol, Outcomes, Systematic reviewAbstract
The responsibilities of caring for the newborn are affected by factors before, during and immediately after caesarean section. Enhanced recovery after caesarean section (ERAC) enables faster return to preoperative functions and thus, has beneficial effects on the mother and her infant. Authors conducted a systematic review of the literature in January 2025 that involved searching 4 databases for peer-reviewed articles on ERAC protocol and traditional techniques between 2015 and 2024. The year of publication, first author’s country, study design, sample size, gestational age, indications for surgery, type of caesarean section and other key findings were extracted from the articles that met the inclusion criteria. The full articles, abstracts, guidelines and conference papers retrieved were 467 with 450 removed for duplications, only abstracts, being guidelines, not meeting our targets and publications outside the stated years. Only 17 articles were included in the review. The primary authors of the included articles originated from 8 countries spanning four (4) continents and 41.2% came from Asia, 23.5% from Africa, and 17.6% each from North America and Europe. Majority (35.3%) of the articles were randomized controlled trials and 29.4% were cohort studies. Interestingly, 88.2% of the articles were published in the last 5 years. Only one study (5.9%) discussed the parental sense of security following discharge from hospital. The socio-demographic variables, past obstetrics, types of caesarean section, gestational age at delivery and type of anaesthesia were factors affecting the success of enhanced recovery after caesarean section and its outcomes.
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References
Incerpi MH. Operative Delivery. In: DeCherney AH, Nathan L, editors. Current Diagnosis and Treatment: Obstetrics and Gynaecology. 11th Edition. McGraw-Hill Companies, New-York. 2013;341-7.
Betran AP, Ye J, Moller AB, Zhang J, Gulmezoglu AM, Torloni MR. The Inreasing Trend in Caesarean Section Rates: Global, Regiional amd National Estimates: 1990-2014. Plos One. 2016;11(2):e0148343. DOI: https://doi.org/10.1371/journal.pone.0148343
Hochstatter R, Schutz A, Taumberger N, Bornemann-Cimenti H, Oppelt P, Fazelnia C, et al. Enhanced recovery after cesarean section (ERAC): Where are we in Austria? Eur J Obstet Gynaecol Reprod Biol. 2023;285:81-5. DOI: https://doi.org/10.1016/j.ejogrb.2023.03.043
Ugwu EO, Obioha KC, Okezie OA, Ugwu AO. A five-year survey of caesarean delivery at a Nigerian tertiary hospital. Ann Med Health Sci Res. 2011;1(1):77-83.
Adekanle DA, Adeyemi AS, Fasanu AO. Caesarean section at a tertiary institution in South-western Nigeria: A 6-year audit. Open J Obstet Gynaecol. 2013;3:357-61. DOI: https://doi.org/10.4236/ojog.2013.33066
Betran AP, Torloni MR, Zhang J, Gulmezoglu AM. World Health Organization (WHO) Working Group on Caesarean Section Rates. BJOG. 2016;123(5):667-70. DOI: https://doi.org/10.1111/1471-0528.13526
Liu ZQ, Du WJ, Yao SL. Enhanced Recovery After Caesarean section: a challenge for Anaesthesiologists. Chin Med J (Engl). 2020;133(5):590-6. DOI: https://doi.org/10.1097/CM9.0000000000000644
Sultan P, Sharawi N, Blake L, Carvalho B. Enhanced recovery after caesarean delivery versus standard care studies: a systematic review of interventions and outcomes. Int J Obstet Anaesth. 2020;43:72-86. DOI: https://doi.org/10.1016/j.ijoa.2020.03.003
Patel K, Zakowski M. Enhanced Recovery After Cesarean section: Current and Emerging Trends. Curr Anesthesiol Rep. 2022;11(2):136-44. DOI: https://doi.org/10.1007/s40140-021-00442-9
Wilson R D, Caughey A B, Wood S L, Macones G A, Wrench I J, Huang J, et al. Guildelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1). Am J Obstet Gynecol. 2018;219(6):523. DOI: https://doi.org/10.1016/j.ajog.2018.09.015
Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, et al. Guildelines for intraoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2). Am J Obstet Gynecol. 2018;219(6):533-44. DOI: https://doi.org/10.1016/j.ajog.2018.08.006
Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, et al. Guildelines for Postoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 3). Am J Obstet Gynecol. 2018;221(3):247. DOI: https://doi.org/10.1016/j.ajog.2019.04.012
Pujic B, Kendrisic M, Shotwell M, Shi Y, Baysinger CL. A Survey of Enhanced Recovery After Surgery Protocols for Cesarean Delivery in Serbia. Front Med (Lausanne). 2018;5:100. DOI: https://doi.org/10.3389/fmed.2018.00100
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: A meta-analysis of randomized controlled trials in colorectal surgery. Surgery. 2011;149(6):830-40. DOI: https://doi.org/10.1016/j.surg.2010.11.003
Anderson AD, McNaught CE, MacFie J, Tring I, Barker P, Mitchell CJ. Randomized clinical trial of multimodal optimization and standard perioperative surgical care. Br J Surg. 2003;90(12):1497-504. DOI: https://doi.org/10.1002/bjs.4371
Teigen NC, Sahasrabudhe N, Doulaveris G, Xie X, Negassa A, Bernstein J, et al. Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of stay: a randomized controlled trial. Am J Obstet Gynecol. 2020;222:372. DOI: https://doi.org/10.1016/j.ajog.2019.10.009
Emam AMM, Elhakm EMA, Said NE. Implementing Enhanced Recovery Pathway after Surgery Protocol for Women Undergoing Cesarean Section Delivery. Egypt J Health Care. 2021;12(3):1925-43. DOI: https://doi.org/10.21608/ejhc.2021.278631
Gupta S, Gupta A, Baghel AS, Sharma K, Choudhary S, Choudhary V. Enhanced Recovery After Cesarean Protocol Versus Traditional Protocol in Elective Cesarean Section: A Prospective Observational Study. J Obstet Anaesth Crit Care. 2022;12(1):28-33. DOI: https://doi.org/10.4103/JOACC.JOACC_16_22
Sravani P, Pravalina R, Sahoo G, Pati BK. Comparative study between ERAS protocol and conventional perioperative care in elective cesarean section patients in a tertiary care centre of eastern India. J Public Health Dev. 2023;21(3):94-106. DOI: https://doi.org/10.55131/jphd/2023/210308
Mundhra R, Gupta DK, Bahadur A, Kumar A. Effects of Enhanced Recovery after Surgery (ERAS) protocol on maternal outcomes following emergency caesarean delivery: A randomized controlled trial. Eur J Obstet Gynecol Reprod Bio X. 2024;22:100295. DOI: https://doi.org/10.1016/j.eurox.2024.100295
Ismail NHA, Ashour ES, Elhomosy SM. Impact of Enhanced Recovery pathway Application Outcomes on Nurses and women undergoing Cesarean section. Egypt J Health Care. 2021;12(4):422-41. DOI: https://doi.org/10.21608/ejhc.2021.200070
Shinnick JK, Ruhotina M, Has P, Kelly BJ, Brousseau EC, O'Brien J, et al. Enhanced Recovery after Surgery for Cesarean Delivery Decreases Length of Hospital Stay and Opioid Consumption: A Quality Improvement Initiative. Am J Perinatol. 2021;38(S 01):e215-23. DOI: https://doi.org/10.1055/s-0040-1709456
Paripurna Y, Puspitasari CDC, Trianasari N. Comparison of Operating Costs and LOS of Cesarean sectionPatients Using ERACS and Non-ERACS Method. Jurnal Jaminan Kesehatan Nasional. 2024;4(1):1-12. DOI: https://doi.org/10.53756/jjkn.v4i1.142
Kruse AR, Lauszus FF, Forman Axel, Kesmodel US, Rugaard MB, Knudsen RK, et al. Effect of early discharge after planned cesarean section on recovery and parental sense of security. A randomized clinical trial. Acta Obstet Gynecol Scand. 2021;100(5):955-63. DOI: https://doi.org/10.1111/aogs.14041
Fay EE, Hitti JE, Delgado CM, Mills EB, Slater JL, Bollag LA, et al. An enhanced recovery after surgery pathway for caesarean delivery decreases hospital stay and cost. Am J Obstet Gynecol. 2019;221;349.e1-9. DOI: https://doi.org/10.1016/j.ajog.2019.06.041
Darwish A, Mustafa Manal, Youness E, Al-Harazi B. Enhanced Recovery after Cesarean Section (CS) versus Conventional Care in a Lower Middle-Income Country: A Randomized Controlled Trial. Open J Nurs. 2022;12(12):831-41. DOI: https://doi.org/10.4236/ojn.2022.1212058
Mansouri R, Sadi A, Ziane H, Fellah N. Effects of early rehabilitation on enhanced recovery after caesarean section. Afr J Reprod Health. 2023;27(9):134-42.
Klangprapan N, Narkwichean A, Luanpholcharenchai J, Laosooksathit W. Effectiveness of the ERAS protocol following Elective Cesarean section: A single center Randomized Controlled Trial. Thai J Obstet Gynaecol. 2022;30(6):393-402.
Agustina NN, Hilal M, Rudi Prihatno M, Sutrisno S, Mulyanto J, Rujito L. Enhanced Recovery After Caesarean Surgery (ERACS) versus Non-ERACS Delivery: A comparative study on the Effectiveness of Exclusive and Early Initiation of Breastfeeding. Iran J Pediatr. 2024;34(2):e144436. DOI: https://doi.org/10.5812/ijp-144436
Kanninga R, Guruvare S, Prabhu. Impact of Multimodal Enhanced Recovery after Cesarean Delivery Protocol Including TRansversus AbdominisPlane Block on Postoperative Pain and Recovery after Cesarean Deliveries: An Experience at a Tertiary Hospital in South India. J South Asian Feder Obst Gynae. 2022;14(2):117-21. DOI: https://doi.org/10.5005/jp-journals-10006-2035
Pujic B, Vejnnovic T, Jovanovic L, Vejnovic A, Palmer C. Initiation of an Enhanced Recovery After Cesarean Delivery Protocol in a University Hospital in Serbia: A randomized comparison with existing management. Pain Med. 2022;4(7):32-41. DOI: https://doi.org/10.31636/pmjua.v7i4.4