- The Enhanced Recovery After Surgery (ERAS) process has been applied to obstetrical care and yielded recommendations for perioperative care for cesarean delivery (CD).
Why this matters
- ERAS is a standardized, perioperative care program that is embedded in a number of surgical specialties and has been shown to improve clinical outcomes.
- To prevent postoperative infections:
- CD performed before rupture of membranes (ROM) and chorioamnionitis is considered a clean/class I incision; narrow-spectrum, first-generation cephalosporin is recommended 30-60 minutes before incision.
- A CD with ROM in labor or with chorioamnionitis is considered a clean contaminated/class II incision; broaden antibiotic coverage by adding azithromycin.
- Prior to admission, suggest bathing with antimicrobial soap.
- Preoperative chlorhexidine-alcohol scrub is preferred.
- Vaginal prep should be considered with ROM/labor.
- Regional anesthesia is preferred.
- Prevention of hypothermia:
- Appropriate monitoring.
- Forced air warming.
- Increasing operating room temperatures.
- Surgical techniques/issues:
- Blunt expansion of uterine incision.
- Closure of uterine incision in 2 layers may reduce risk for future uterine rupture.
- Peritoneum does not need to be closed.
- Skin should be closed with subcuticular suture.
- If subcutaneous layer >2 cm, reapproximation of this layer should be performed.
- Neonatal concerns:
- Delayed cord clamping x 60 seconds.
- Routine suctioning should be avoided.
- Literature search and expert commentary.
- Quality assessment of each article.
- Funding: None.
- Recommendations may change.