ERAS guidelines for antenatal and preoperative care in caesarean delivery
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The Enhanced Recovery after Surgery (ERAS) Society recently published Part 1 of the Society’s 3-part caesarean delivery guidelines, focussed on pre-operative care for women undergoing scheduled and unscheduled caesarean delivery, in the American Journal of Obstetrics & Gynecology.1Wilson RD, et al. Am J Obstet Gynecol 2018;219(6):523.e1-523.e15. doi: 10.1016/j.ajog.2018.09.015.
Caesarean delivery is the most common surgical procedure in the modern world.
The newly release ERAS caesarean delivery guideline aims to enhance the quality and safety of the caesarean delivery and to improve both maternal and fetal/neonatal outcomes.
A literature search using Embase and PubMed articles published between 1996 and 2017 was performed by an ERAS Society Guideline Committee selected author panel. Individual reviewers screened the titles and abstracts of selected studies to identify potentially relevant articles. The board then evaluated the quality of evidence and recommendations according to the Grading of Recommendations, Assessment, Development, and Evaluation system. Whereas a weak recommendation indicates that the panel is less confident on the intervention, a strong recommendation shows the panel’s confidence that the effectivity outweighs the undesirable effects (Table 1).
The trade-offs are less certain, due to:
Evidence suggests the desirable and undesirable effects are closely balanced.
The desirable effects of an intervention:
Clearly outweigh the undesirable effects;
Clearly do not outweigh the undesirable effects.
Table 1. recommendation grading according to the Grading of Recommendations, Assessment, Development, and Evaluation system.
Table 2 summarises the ERAS Society’s evidence-based recommendations for process-directed maternal care for the preoperative caesarean delivery guidelines for improved surgical quality and safety during obstetric surgical deliveries promoting the enhanced recovery for maternal and fetal/neonatal outcome.
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