ERAS Protocol on Maternal and Fetal Outcomes Following Elective Cesarean Section: a Controlled Trial

Methods After obtaining approval of the institutional ethics committee (Decision number: 502/Date: 31.05.2021) and written informed consent from the parturients, data were collected prospectively in 450 ASA II or III term pregnant women aged ≥18 years scheduled to undergo elective CS under spinal anesthesia between June 2021 and June 2023. Gazi University Hospital, which is a re-accredited tertiary care referral center by ESAIC (European Society of Anaesthesiology and Intensive Care), has an annual rate of approximately 1400 deliveries. Parturients younger than <18 years old with fetal compromise, ASA IV or V physical status and emergency cases were not included in this study. The ERAS protocol introduced for our unit was adapted from the SOAP. Following approval of the ERAS protocol by the obstetric team and the participants, two groups were assigned as; ERAS group (n=150) and control group (n=300) who would receive standard care of the unit. The data of the parturients having standard care were compared with those who were enrolled in the ERAS pathway.

Features of ERAS implementation and standard care in the study Step 1. Preoperative (Antepartum) Components

1. Enrolled patients were seen in the antenatal clinic to give face to face education including information about fasting, CS and/or anesthesia, antimicrobial prophylaxis, skin washing, breastfeeding preparation and support by the principal researcher anesthesiologist for ERAS pathway to improve patient understanding and engagement in their own care.
2. Principally fasting 6 hours (h) for solids and 2 h for clear fluids was provided. To standardize fasting duration according to the scheduled time of surgery in the ERAS group, parturients who were scheduled for CS before 12:00 PM were allowed to have breakfast at 2:00 AM, while the rest scheduled for CS after 12:00 PM were allowed to have breakfast at 6:00 AM. On the morning of surgery, parturients either diabetic or non-diabetic in the ERAS implemented group were given a carbohydrate solution prepared by the principal researcher anesthesiologist containing 25 g of maltodextrin in 330 mL approximately 2 h prior to surgery.

The control group fasted after 12:00 AM regardless of the scheduled CS time and no carbohydrate solution was administered prior to surgery. 3. Anemia screening and treatment for hemoglobin optimization was done in both groups.

Step 2. Perioperative (Intrapartum) Components