Systematic review of enhanced recovery protocols for elective caesarean section versus conventional care

BACKGROUND: Enhanced recovery protocols for caesarean section have been introduced in many maternity units with the aim of improving clinical outcomes and improving service efficiency. AIM: Our aim was to assess the available evidence for the efficacy of enhanced recovery protocols for elective caesarean section compared to conventional care. MATERIALS AND METHODS: A systematic review was performed through a search of MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials Database. RESULTS: After screening 118 records and reviewing 38 articles, no studies met the inclusion criteria for this systematic review. However, from ten articles we were able to describe 29 individual interventions that are included in the enhanced recovery pathways of care for elective caesarean sections. Early reintroduction of fluids and food was the only intervention that was common to all pathways. CONCLUSION: This review reveals that while the adoption of enhanced recovery pathways for caesarean sections is increasing, there remains a paucity of evidence in the published literature on outcomes. This is reflected in the significant heterogeneity of the individual components included in various pathways currently in practice. Furthermore, development of standardised outcome metrics is required to facilitate meaningful comparison of multiple interventions. Further well-designed research is needed to properly assess the potential benefits of these interventions to improve maternal outcomes after obstetric surgery.