Enhanced Recovery After Surgery Programs in Cesarean Delivery: Review of the Literature

Enhanced Recovery After Surgery (ERAS) programs have been improved surgical outcomes in many surgical sub-specialties, since the early 2000s. This multidisciplinary standardized care program aimed to optimize preoperative, intraoperative, and postoperative care of patients undergoing surgery. Recent reports showed that the ERAS protocols have been successfully implemented in cesarean deliveries. The key elements of ERAS program in cesarean delivery are antenatal education/counseling, preoperative medical optimization, preanesthetic medication, limited fasting time, carbohydrate supplementation, intraoperative anesthetic management, surgical site infection prophylaxis, maintenance of normothermia and euvolemia, appropriate surgical technique, newborn care, postoperative analgesia, prevention of nausea and vomiting, early feeding, early mobilization, thromboembolism prophylaxis, glucose management, urinary management, and discharge counseling. The implementation of these elements resulted with improved maternal/neonatal outcomes and reduced length of hospital stay. However, the current literature on this topic is not enough to develop a standardized globally implemented ERAS protocol for cesarean delivery. Further studies are required to enhance the care program and recommendations.