Effectiveness of a Modified Enhanced Recovery After Surgery (mERAS) Protocol in Reducing Surgical Site Infection After Emergency Cesarean Delivery: A Randomized Controlled Trial.”

Enhanced Recovery After Surgery (ERAS) is a comprehensive, evidence-based approach designed to minimize the physiological stress associated with surgical procedures, facilitate functional recovery, reduce complications, and shorten hospital stays. Initially developed for colorectal and significant abdominal surgeries, the ERAS principles have since been adapted to obstetric care, particularly in cesarean deliveries. These guidelines focus on optimizing various aspects of post-surgical care, such as pain management, early mobilization, fluid management, nutritional support, and encouraging early contact between mother and infant. Guidelines from the ERAS Society delineate specific recommendations tailored for peri-cesarean care, which can be applied in both elective and emergency contexts. Research has led to the establishment of a modified ERAS (mERAS) protocol that prioritizes certain postoperative factors—such as facilitating early oral intake, implementing multimodal analgesia, promoting early movement, and ensuring prompt removal of urinary catheters—with evidence suggesting that these modifications can be safely employed in emergency situations, based on studies of emergent colorectal surgeries. However, emergency cesarean deliveries present unique challenges. These include the urgency of the procedure, variability in preoperative preparation, a heightened baseline risk of infection, and the limited time available for preparatory measures. Therefore, it is essential to investigate whether implementing modified ERAS protocols can yield benefits, such as a reduction in surgical site infections (SSIs), while ensuring the safety of both mothers and their newborns. Current evidence supporting the application of ERAS in emergency cesarean deliveries remains less robust compared to that for elective cesarean births.