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Enhanced Recovery After Cesarean Delivery: Improving Patient Outcomes

  • Patient Safety in Anesthesia (SJ Brull and JR Renew, Section Editors)
  • Published:
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Abstract

Purpose of Review

This review summarizes the updated literature on enhanced recovery after cesarean delivery. It provides evidence-based guidance on the components of the most recent recommendations related to enhanced recovery after cesarean delivery.

Recent Findings

The Society for Obstetric Anesthesia and Perinatology, The American College of Obstetricians and Gynecologists, and the Enhanced Recovery after Surgery Society provide updated recommendations related to enhanced recovery after cesarean delivery. Additional studies and systematic reviews have been published and have found implementation of enhanced recovery pathways are associated with reduction in hospital length of stay, time to first mobilization, time to urinary catheter removal, postoperative pain scores, opioid consumption, and costs. When pathways were initially developed, there were not many studies on obstetric patients, but the literature evaluating many of the components has grown.

Summary

Implementation of enhanced recovery pathways are associated with improved maternal outcomes. Future studies should incorporate patient-reported outcome measures.

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Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2021. Natl Vital Stat Rep. 2023;72(1):1–53.

    PubMed  Google Scholar 

  2. Betran AP, Ye J, Moller AB, Souza JP, Zhang J. Trends and projections of caesarean section rates: global and regional estimates. BMJ Glob Health. 2021;6(6):e005671. https://doi.org/10.1136/bmjgh-2021-005671.

  3. •• Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M, et al. Society for obstetric anesthesia and perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132(5):1362–77. https://doi.org/10.1213/ane.0000000000005257. (Consensus statement focuses on anesthesia-related and perioperative components of an enhanced recovery pathway after cesarean delivery with practical and evidence-based recommendations.)

    Article  PubMed  Google Scholar 

  4. ACOG Committee Opinion No. 750: Perioperative Pathways: Enhanced Recovery After Surgery. Obstet Gynecol. 2018;132(3):e120-e130. https://doi.org/10.1097/AOG.0000000000002818. Erratum in: Obstet Gynecol. 2019;133(6):1288. Erratum in: Obstet Gynecol. 2019;134(5):1121.

  5. • Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, et al. Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery after Surgery Society recommendations (Part 1). Am J Obstet Gynecol. 2018;219(6):523.e1-e15. https://doi.org/10.1016/j.ajog.2018.09.015. (Enhanced Recovery after Surgery Society guidelines for antenatal and preoperative care in cesarean delivery provide best practice, evidence-based recommendations with a maternal focus.)

    Article  PubMed  Google Scholar 

  6. • Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, et al. Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery after Surgery Society recommendations (Part 2). Am J Obstet Gynecol. 2018;219(6):533–44. https://doi.org/10.1016/j.ajog.2018.08.006. (Enhanced Recovery after Surgery Society guidelines for intraoperative care in cesarean delivery provide best practice, evidence-based recommendations with a maternal focus.)

    Article  PubMed  Google Scholar 

  7. • Macones GA, Caughey AB, Wood SL, Wrench IJ, Huang J, Norman M, et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery after Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol. 2019;221(3):247.e1-e9. https://doi.org/10.1016/j.ajog.2019.04.012. (Enhanced Recovery after Surgery Society guidelines for postoperative care in cesarean delivery provide best practice, evidence-based recommendations with a maternal focus.)

    Article  PubMed  Google Scholar 

  8. Enhanced Recovery Canada. Clinical pathway for cesarean delivery. 2022. Available at https://www.healthcareexcellence.ca/media/vttlbbbv/20230308_erc_csection_clinicalpathway_en.pdf. Accessed 23 Nov 2023.

  9. Karami M, Chaleshgar M, Salari N, Akbari H, Mohammadi M. Global prevalence of anemia in pregnant women: a comprehensive systematic review and meta-analysis. Matern Child Health J. 2022;26(7):1473–87. https://doi.org/10.1007/s10995-022-03450-1.

    Article  PubMed  Google Scholar 

  10. Le CH. The prevalence of anemia and moderate-severe anemia in the US population (NHANES 2003–2012). PLoS One. 2016;11(11):e0166635. https://doi.org/10.1371/journal.pone.0166635.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Anemia in pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55-e64. https://doi.org/10.1097/aog.0000000000004477.

  12. Lewkowitz AK, Gupta A, Simon L, Sabol BA, Stoll C, Cooke E, et al. Intravenous compared with oral iron for the treatment of iron-deficiency anemia in pregnancy: a systematic review and meta-analysis. J Perinatol. 2019;39(4):519–32. https://doi.org/10.1038/s41372-019-0320-2.

    Article  CAS  PubMed  Google Scholar 

  13. Kehinde J, O’Donnell C, Grealish A. The effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum: a systematic review. Midwifery. 2023;118:103579. https://doi.org/10.1016/j.midw.2022.103579.

    Article  PubMed  Google Scholar 

  14. Carli F. Physiologic considerations of Enhanced Recovery after Surgery (ERAS) programs: implications of the stress response. Can J Anaesth. 2015;62(2):110–9. https://doi.org/10.1007/s12630-014-0264-0.

    Article  PubMed  Google Scholar 

  15. Stadler M, Nuyens V, Seidel L, Albert A, Boogaerts JG. Effect of nutritional status on oxidative stress in an ex vivo perfused rat liver. Anesthesiology. 2005;103(5):978–86. https://doi.org/10.1097/00000542-200511000-00012.

    Article  PubMed  Google Scholar 

  16. Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, et al. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med (Lond). 2016;5:24. https://doi.org/10.1186/s13741-016-0049-9.

    Article  PubMed  Google Scholar 

  17. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Task Force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376–93. https://doi.org/10.1097/aln.0000000000001452.

  18. Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013;32(1):34–44. https://doi.org/10.1016/j.clnu.2012.10.011.

    Article  CAS  PubMed  Google Scholar 

  19. Kubli M, Scrutton MJ, Seed PT, O’Sullivan G. An evaluation of isotonic “sport drinks” during labor. Anesth Analg. 2002;94(2):404–8. https://doi.org/10.1097/00000539-200202000-00033. (table of contents).

    Article  PubMed  Google Scholar 

  20. Clark A, Litchfield K, Hannah S, Love C, Slade K, Lake K, et al. Pre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial. Int J Obstet Anesth. 2021;45:21–7. https://doi.org/10.1016/j.ijoa.2020.10.008.

    Article  CAS  PubMed  Google Scholar 

  21. He Y, Liu C, Han Y, Huang Y, Zhou J, Xie Q. The impact of oral carbohydrate-rich supplement taken two hours before caesarean delivery on maternal and neonatal perioperative outcomes–a randomized clinical trial. BMC Pregnancy Childbirth. 2021;21(1):682. https://doi.org/10.1186/s12884-021-04155-z.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Yang C, Cheng Y, Liu S, Huang S, Yu X. Effect of preoperative oral carbohydrate loading on body temperature during combined spinal-epidural anesthesia for elective cesarean delivery. Anesth Analg. 2021;133(3):731–8. https://doi.org/10.1213/ane.0000000000005447.

    Article  CAS  PubMed  Google Scholar 

  23. Liu J, Dong S, Li W, Yu X, Huang S. Effect of early oral carbohydrate intake after elective cesarean delivery on maternal body temperature and satisfaction: a randomized controlled trial. Can J Anaesth. 2023;70(10):1623–34. https://doi.org/10.1007/s12630-023-02564-6.

    Article  CAS  PubMed  Google Scholar 

  24. •• Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, et al. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71–92. https://doi.org/10.1111/anae.14080. ( International consensus of experts on the most effective ways to prevent and treat hypotension during cesarean delivery.)

    Article  CAS  PubMed  Google Scholar 

  25. Butwick AJ, Columb MO, Carvalho B. Preventing spinal hypotension during caesarean delivery: what is the latest? Br J Anaesth. 2015;114(2):183–6. https://doi.org/10.1093/bja/aeu267.

    Article  CAS  PubMed  Google Scholar 

  26. • Singh PM, Singh NP, Reschke M, Ngan Kee WD, Palanisamy A, Monks DT. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes. Br J Anaesth. 2020;124(3):e95–107. https://doi.org/10.1016/j.bja.2019.09.045. (A network meta-analysis evaluating vasopressor drugs for managing hypotension during neuraxial anesthesia during cesarean delivery.)

    Article  CAS  PubMed  Google Scholar 

  27. Belin O, Casteres C, Alouini S, Le Pape M, Dupont A, Boulain T. Manually controlled, continuous infusion of phenylephrine or norepinephrine for maintenance of blood pressure and cardiac output during spinal anesthesia for cesarean delivery: a double-blinded randomized study. Anesth Analg. 2023;136(3):540–50. https://doi.org/10.1213/ane.0000000000006244.

    Article  CAS  PubMed  Google Scholar 

  28. du Toit L, van Dyk D, Hofmeyr R, Lombard CJ, Dyer RA. Core temperature monitoring in obstetric spinal anesthesia using an ingestible telemetric sensor. Anesth Analg. 2018;126(1):190–5. https://doi.org/10.1213/ane.0000000000002326.

    Article  PubMed  Google Scholar 

  29. Jun JH, Chung MH, Jun IJ, Kim Y, Kim H, Kim JH, et al. Efficacy of forced-air warming and warmed intravenous fluid for prevention of hypothermia and shivering during caesarean delivery under spinal anaesthesia: a randomised controlled trial. Eur J Anaesthesiol. 2019;36(6):442–8. https://doi.org/10.1097/eja.0000000000000990.

    Article  PubMed  Google Scholar 

  30. Simegn GD, Bayable SD, Fetene MB. Prevention and management of perioperative hypothermia in adult elective surgical patients: a systematic review. Ann Med Surg (Lond). 2021;72:103059. https://doi.org/10.1016/j.amsu.2021.103059.

    Article  PubMed  Google Scholar 

  31. Heesen M, Carvalho B, Carvalho JCA, Duvekot JJ, Dyer RA, Lucas DN, et al. International consensus statement on the use of uterotonic agents during caesarean section. Anaesthesia. 2019;74(10):1305–19. https://doi.org/10.1111/anae.14757.

    Article  CAS  PubMed  Google Scholar 

  32. Davis PR, Sviggum HP, Arendt KW, Pompeian RJ, Kurian C, Torbenson VE, et al. Effect of an oxytocin protocol on secondary uterotonic use in patients undergoing cesarean delivery. Can J Anaesth. 2023;70(7):1194–201. https://doi.org/10.1007/s12630-023-02496-1.

    Article  CAS  PubMed  Google Scholar 

  33. Ende HB, French B, Shi Y, Kertai MD, Osmundson SS, Bauchat JR. Development of clinical risk-prediction models for uterine atony following vaginal and cesarean delivery. Int J Obstet Anesth. 2022;51:103550. https://doi.org/10.1016/j.ijoa.2022.103550.

    Article  CAS  PubMed  Google Scholar 

  34. Masse N, Dexter F, Wong CA. Prophylactic methylergonovine and oxytocin compared with oxytocin alone in patients undergoing intrapartum cesarean birth: a randomized controlled trial. Obstet Gynecol. 2022;140(2):181–6. https://doi.org/10.1097/aog.0000000000004857.

    Article  CAS  PubMed  Google Scholar 

  35. Sentilhes L, Bénard A, Madar H, Froeliger A, Petit S, Deneux-Tharaux C. Tranexamic acid for reduction of blood loss after caesarean delivery: a cost-effectiveness analysis of the TRAAP2 trial. Br J Anaesth. 2023;131(5):893–900. https://doi.org/10.1016/j.bja.2023.07.028.

    Article  CAS  PubMed  Google Scholar 

  36. Lee SH, Kwek ME, Tagore S, Wright A, Ku CW, Teong ACA, et al. Tranexamic acid, as an adjunct to oxytocin prophylaxis, in the prevention of postpartum haemorrhage in women undergoing elective caesarean section: a single-centre double-blind randomised controlled trial. BJOG. 2023;130(9):1007–15. https://doi.org/10.1111/1471-0528.17445.

    Article  CAS  PubMed  Google Scholar 

  37. Lange SM, Sharpe EE, Hertzfeldt DN, Schroeder DR, Sviggum HP. Effect of penicillin allergy on prophylactic antibiotic administration in the parturient undergoing cesarean delivery. Acta Anaesthesiol Scand. 2021;65(3):329–34. https://doi.org/10.1111/aas.13730.

    Article  CAS  PubMed  Google Scholar 

  38. Cooper JJ, Atluri VL, Jain R, Pottinger PS, Coleman DT. Safety of cefazolin for perioperative prophylaxis in patients with penicillin allergy labels. Ann Allergy Asthma Immunol. 2022;129(1):115–7. https://doi.org/10.1016/j.anai.2022.03.015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Sousa-Pinto B, Blumenthal KG, Courtney L, Mancini CM, Jeffres MN. Assessment of the frequency of dual allergy to penicillins and cefazolin: a systematic review and meta-analysis. JAMA Surg. 2021;156(4): e210021. https://doi.org/10.1001/jamasurg.2021.0021.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin No. 199: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2018;132(3):e103-e119. https://doi.org/10.1097/AOG.0000000000002833. Erratum in: Obstet Gynecol. 2019;134(4):883-884.

  41. • Hailu S, Mekonen S, Shiferaw A. Prevention and management of postoperative nausea and vomiting after cesarean section: a systematic literature review. Ann Med Surg (Lond). 2022;75:103433. https://doi.org/10.1016/j.amsu.2022.103433. (Systematic review detailing the best practices for preventing and treating nausea and vomiting, including specific agents, at the time of cesarean delivery.)

    Article  PubMed  Google Scholar 

  42. Tan HS, Habib AS. The optimum management of nausea and vomiting during and after cesarean delivery. Best Pract Res Clin Anaesthesiol. 2020;34(4):735–47. https://doi.org/10.1016/j.bpa.2020.04.012.

    Article  PubMed  Google Scholar 

  43. Sharpe EE, Molitor RJ, Arendt KW, Torbenson VE, Olsen DA, Johnson RL, et al. Intrathecal morphine versus intrathecal hydromorphone for analgesia after cesarean delivery: a randomized clinical trial. Anesthesiology. 2020;132(6):1382–91. https://doi.org/10.1097/aln.0000000000003283.

    Article  CAS  PubMed  Google Scholar 

  44. Borrelli MC, Sprowell AJ, Moldysz A, Idris M, Armstrong SL, Kowalczyk JJ, et al. A randomized controlled trial of spinal morphine with an enhanced recovery pathway and its effect on duration of analgesia after cesarean delivery. Anaesth Crit Care Pain Med. 2023;43(1):101309. https://doi.org/10.1016/j.accpm.2023.101309.

    Article  PubMed  Google Scholar 

  45. El-Boghdadly K, Desai N, Halpern S, Blake L, Odor PM, Bampoe S, et al. Quadratus lumborum block vs. transversus abdominis plane block for caesarean delivery: a systematic review and network meta-analysis(). Anaesthesia. 2021;76(3):393–403. https://doi.org/10.1111/anae.15160.

    Article  CAS  PubMed  Google Scholar 

  46. Yang TR, He XM, Li XH, Wang RR. Intrathecal morphine versus transversus abdominis plane block for caesarean delivery: a systematic review and meta-analysis. BMC Anesthesiol. 2021;21(1):174. https://doi.org/10.1186/s12871-021-01392-9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Viviand C, Pietretti E, Luc A, Herbain D, Baka N, Morel O, et al. Continuous wound infusion combined with intrathecal morphine for analgesia after cesarean delivery compared with intrathecal morphine or continuous wound infusion alone. Can J Anaesth. 2022;69(6):788–9. https://doi.org/10.1007/s12630-022-02223-2.

    Article  CAS  PubMed  Google Scholar 

  48. Lee LO, Ramirez-Chapman AL, White DL, Zhang X, Lu M, Suresh MS. Postcesarean analgesia with epidural morphine after epidural 2-chloroprocaine: a randomized noninferiority trial. Anesth Analg. 2023;136(1):86–93. https://doi.org/10.1213/ane.0000000000006109.

    Article  CAS  PubMed  Google Scholar 

  49. Widström AM, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019;108(7):1192–204. https://doi.org/10.1111/apa.14754.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kirca N, Adibelli D. Effects of mother-infant skin-to-skin contact on postpartum depression: a systematic review. Perspect Psychiatr Care. 2021;57(4):2014–23. https://doi.org/10.1111/ppc.12727.

    Article  PubMed  Google Scholar 

  51. McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Evid Based Child Health. 2014;9(2):303–97. https://doi.org/10.1002/ebch.1971.

    Article  PubMed  Google Scholar 

  52. Committee Opinion No. 684: Delayed umbilical cord clamping after birth. Obstet Gynecol. 2017;129(1):1. https://doi.org/10.1097/aog.0000000000001860.

  53. Huang H, Wang H, He M. Early oral feeding compared with delayed oral feeding after cesarean section: a meta-analysis. J Matern Fetal Neonatal Med. 2016;29(3):423–9. https://doi.org/10.3109/14767058.2014.1002765.

    Article  PubMed  Google Scholar 

  54. Basbug A, Yuksel A, Ellibeş KA. Early versus delayed removal of indwelling catheters in patients after elective cesarean section: a prospective randomized trial. J Matern Fetal Neonatal Med. 2020;33(1):68–72. https://doi.org/10.1080/14767058.2018.1487394.

    Article  PubMed  Google Scholar 

  55. Mirza F, Carvalho B. Transversus abdominis plane blocks for rescue analgesia following cesarean delivery: a case series. Can J Anaesth. 2013;60(3):299–303. https://doi.org/10.1007/s12630-012-9866-6.

    Article  PubMed  Google Scholar 

  56. Krenitsky N, Friedman AM, Yu K, Gyamfi-Bannerman C, Williams-Kane J, O’Shaugnessy F, et al. Trends in venous thromboembolism and associated risk factors during delivery hospitalizations from 2000 to 2018. Obstet Gynecol. 2022;139(2):223–34. https://doi.org/10.1097/aog.0000000000004648.

    Article  PubMed  Google Scholar 

  57. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 196: Thromboembolism in pregnancy. Obstet Gynecol. 2018;132(1):e1-e17. https://doi.org/10.1097/AOG.0000000000002706. Erratum in: Obstet Gynecol. 2018;132(4):1068.

  58. Federspiel JJ, Suresh SC, Darwin KC, Szymanski LM. Hospitalization duration following uncomplicated cesarean delivery: predictors, facility variation, and outcomes. AJP Rep. 2020;10(2):e187–97. https://doi.org/10.1055/s-0040-1709681.

    Article  PubMed  PubMed Central  Google Scholar 

  59. O’Carroll JE, Zucco L, Warwick E, Arbane G, Moonesinghe SR, El-Boghdadly K, et al. Quality of recovery following childbirth: a prospective, multicentre cohort study. Anaesthesia. 2023;78(9):1071–80. https://doi.org/10.1111/anae.16039.

    Article  PubMed  Google Scholar 

  60. ACOG Committee Opinion No. 736: Optimizing postpartum care. Obstet Gynecol. 2018;131(5):e140-e50. https://doi.org/10.1097/aog.0000000000002633.

  61. 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 Anesth. 2020;43:72–86. https://doi.org/10.1016/j.ijoa.2020.03.003.

    Article  CAS  PubMed  Google Scholar 

  62. •• Sultan P, Sharawi N, Blake L, Habib AS, Brookfield KF, Carvalho B. Impact of enhanced recovery after cesarean delivery on maternal outcomes: a systematic review and meta-analysis. Anaesth Crit Care Pain Med. 2021;40(5):100935. https://doi.org/10.1016/j.accpm.2021.100935. (Systematic review to evaluate ERAC implementation which found some benefit and no harm.)

    Article  PubMed  Google Scholar 

  63. Meng X, Chen K, Yang C, Li H, Wang X. The clinical efficacy and safety of Enhanced Recovery after Surgery for cesarean section: a systematic review and meta-analysis of randomized controlled trials and observational studies. Front Med (Lausanne). 2021;8:694385. https://doi.org/10.3389/fmed.2021.694385.

    Article  PubMed  Google Scholar 

  64. Bateman BT, Franklin JM, Bykov K, Avorn J, Shrank WH, Brennan TA, et al. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am J Obstet Gynecol. 2016;215(3):353.e1-e18. https://doi.org/10.1016/j.ajog.2016.03.016.

    Article  PubMed  Google Scholar 

  65. Bollag L, Nelson G. Enhanced recovery after cesarean (ERAC)-beyond the pain scores. Int J Obstet Anesth. 2020;43:36–8. https://doi.org/10.1016/j.ijoa.2020.05.006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Lester SA, Kim B, Tubinis MD, Morgan CJ, Powell MF. Impact of an enhanced recovery program for cesarean delivery on postoperative opioid use. Int J Obstet Anesth. 2020;43:47–55. https://doi.org/10.1016/j.ijoa.2020.01.005.

    Article  CAS  PubMed  Google Scholar 

  67. Kleiman AM, Chisholm CA, Dixon AJ, Sariosek BM, Thiele RH, Hedrick TL, et al. Evaluation of the impact of Enhanced Recovery after Surgery protocol implementation on maternal outcomes following elective cesarean delivery. Int J Obstet Anesth. 2020;43:39–46. https://doi.org/10.1016/j.ijoa.2019.08.004.

    Article  CAS  PubMed  Google Scholar 

  68. Grasch JL, Rojas JC, Sharifi M, McLaughlin MM, Bhamidipalli SS, Haas DM. Impact of Enhanced Recovery after Surgery pathway for cesarean delivery on postoperative pain. AJOG Glob Rep. 2023;3(1):100169. https://doi.org/10.1016/j.xagr.2023.100169.

    Article  PubMed  PubMed Central  Google Scholar 

  69. McCoy JA, Gutman S, Hamm RF, Srinivas SK. The association between implementation of an enhanced recovery after cesarean pathway with standardized discharge prescriptions and opioid use and pain experience after cesarean delivery. Am J Perinatol. 2021;38(13):1341–7. https://doi.org/10.1055/s-0041-1732378.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Chiao SS, Razzaq KK, Sheeran JS, Forkin KT, Spangler SN, Knio ZO, et al. Effect of Enhanced Recovery after Surgery for elective cesarean deliveries on neonatal outcomes. J Perinatol. 2022;42(10):1283–7. https://doi.org/10.1038/s41372-021-01309-x.

    Article  CAS  PubMed  Google Scholar 

  71. Fay EE, Hitti JE, Delgado CM, Savitsky LM, Mills EB, Slater JL, et al. An Enhanced Recovery after Surgery pathway for cesarean delivery decreases hospital stay and cost. Am J Obstet Gynecol. 2019;221(4):349.e1-e9. https://doi.org/10.1016/j.ajog.2019.06.041.

    Article  PubMed  Google Scholar 

  72. O’Carroll J, Carvalho B, Sultan P. Enhancing recovery after cesarean delivery-a narrative review. Best Pract Res Clin Anaesthesiol. 2022;36(1):89–105. https://doi.org/10.1016/j.bpa.2022.01.001.

    Article  PubMed  Google Scholar 

  73. •• Sultan P, George R, Weiniger CF, El-Boghdadly K, Pandal P, Carvalho B. Expert consensus regarding core outcomes for enhanced recovery after cesarean delivery studies: a Delphi study. Anesthesiology. 2022;137(2):201–11. https://doi.org/10.1097/aln.0000000000004263. (International consensus of experts in multiple specialties on a core outcome set of 15 measures for enhanced recovery after cesarean delivery.)

    Article  PubMed  Google Scholar 

  74. Ciechanowicz S, Ke JXC, Sharawi N, Sultan P. Measuring enhanced recovery in obstetrics: a narrative review. AJOG Glob Rep. 2023;3(1):100152. https://doi.org/10.1016/j.xagr.2022.100152.

    Article  PubMed  Google Scholar 

  75. Kowa CY, Jin Z, Gan TJ. Framework, component, and implementation of enhanced recovery pathways. J Anesth. 2022;36(5):648–60. https://doi.org/10.1007/s00540-022-03088-x.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Gramlich LM, Sheppard CE, Wasylak T, Gilmour LE, Ljungqvist O, Basualdo-Hammond C, et al. Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system. Implement Sci. 2017;12(1):67. https://doi.org/10.1186/s13012-017-0597-5.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Joseph KS, Boutin A, Lisonkova S, Muraca GM, Razaz N, John S, et al. Maternal mortality in the United States: recent trends, current status, and future considerations. Obstet Gynecol. 2021;137(5):763–71. https://doi.org/10.1097/aog.0000000000004361.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Statement on reducing maternal peripartum racial and ethnic disparities in anesthesia care. 2021. https://www.asahq.org/standards-and-practice-parameters/statement-on-reducing-maternal-peripartum-racial-and-ethnic-disparities-in-anesthesia-care . Accessed 28 Nov 2023.

  79. Khusid E, Lui B, Williams A, Chaturvedi R, Chen J, White RS. Enhanced recovery after cesarean delivery meta-analysis outcomes by race, ethnicity, insurance, and rurality. Int J Obstet Anesth. 2023;55:103878. https://doi.org/10.1016/j.ijoa.2023.103878.

    Article  CAS  PubMed  Google Scholar 

  80. Landau R. Comparing two simultaneous systematic reviews (a “meta meta-analysis”): reconciling data on enhanced recovery after cesarean delivery research. Anaesth Crit Care Pain Med. 2021;40(5):100956. https://doi.org/10.1016/j.accpm.2021.100956.

    Article  PubMed  Google Scholar 

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  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1St Street S.W., Rochester, MN, 55905, USA

    Hans P. Sviggum & Emily E. Sharpe

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  1. Hans P. Sviggum
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  2. Emily E. Sharpe
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H.P. and E.S. wrote the main manuscript text.

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Correspondence to Emily E. Sharpe.

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Sviggum, H.P., Sharpe, E.E. Enhanced Recovery After Cesarean Delivery: Improving Patient Outcomes. Curr Anesthesiol Rep 14, 121–130 (2024). https://doi.org/10.1007/s40140-023-00606-9

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