摘要
Background: Enhanced recovery after surgery (ERAS) has been tested in a wide variety of surgeries with promising outcomes. However, there is a need for a standardized, evidence-informed approach to both the development of new ERAS Society guidelines, and the adaptation and revision of existing guidelines. Developing countries have limited resources and deserve every effort to improve economic status. Aim of the Study: to evaluate perinatal maternal outcomes of ERAS<sup>?</sup> versus routine care protocols in women undergoing elective cesarean section (CS) in a lower middle-income country with limited resources ranked as a third most country performing CS worldwide using a multidisciplinary team (MDT) management. Design: A prospective randomized Controlled Trial. Setting: Outpatient department (OPD) and labor ward at the Woman’s Health hospital, Assiut University, Egypt. Participants: Healthy pregnant women planned for elective CS (300 women) were randomly divided into a study group offered ERAS protocol and a control group offered regular care. Results: Repeat CS was the main indication of elective CS in both groups without significant difference (89 cases (59.3%) and 75 cases (50%) in both groups respectively). Other indications included cephalopelvic disproportion in 17 cases (11%) and 19 cases (12.6%), placenta previa in 28 (18.6%) and 34 (22.6%) cases, DM in 11 (7%) and 19 (12.6%) cases, and others in 5 (0.3%) and 3 (2%) cases in both groups respectively. The study group took much less time to eat and walk. It had significantly lower pain levels and postoperative problems, as well as much greater women’s satisfaction and a shorter hospital stay (p = 0.001). Conclusions: Collaboration of nursing, obstetricians and anesthesiologists is the cornerstone for a successful ERAS for CS. Significant better perinatal maternal outcomes encourage expansion of ERAS in lower middle-income countries with limited resources.
Background: Enhanced recovery after surgery (ERAS) has been tested in a wide variety of surgeries with promising outcomes. However, there is a need for a standardized, evidence-informed approach to both the development of new ERAS Society guidelines, and the adaptation and revision of existing guidelines. Developing countries have limited resources and deserve every effort to improve economic status. Aim of the Study: to evaluate perinatal maternal outcomes of ERAS<sup>?</sup> versus routine care protocols in women undergoing elective cesarean section (CS) in a lower middle-income country with limited resources ranked as a third most country performing CS worldwide using a multidisciplinary team (MDT) management. Design: A prospective randomized Controlled Trial. Setting: Outpatient department (OPD) and labor ward at the Woman’s Health hospital, Assiut University, Egypt. Participants: Healthy pregnant women planned for elective CS (300 women) were randomly divided into a study group offered ERAS protocol and a control group offered regular care. Results: Repeat CS was the main indication of elective CS in both groups without significant difference (89 cases (59.3%) and 75 cases (50%) in both groups respectively). Other indications included cephalopelvic disproportion in 17 cases (11%) and 19 cases (12.6%), placenta previa in 28 (18.6%) and 34 (22.6%) cases, DM in 11 (7%) and 19 (12.6%) cases, and others in 5 (0.3%) and 3 (2%) cases in both groups respectively. The study group took much less time to eat and walk. It had significantly lower pain levels and postoperative problems, as well as much greater women’s satisfaction and a shorter hospital stay (p = 0.001). Conclusions: Collaboration of nursing, obstetricians and anesthesiologists is the cornerstone for a successful ERAS for CS. Significant better perinatal maternal outcomes encourage expansion of ERAS in lower middle-income countries with limited resources.
作者
Atef Darwish
Manal Mustafa
Entrsar Youness
Bushra Al-Harazi
Atef Darwish;Manal Mustafa;Entrsar Youness;Bushra Al-Harazi(Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt;Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt;Department of Obstetrics and Gynecological Nursing, Faculty of Medicine and Health Sciences-Nursing Department, Sana’a University, Sanaa, Yemen)
