Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes

Journal of Perinatology volume 42, pages 1283–1287 (2022)Cite this article

Subjects

Abstract

Objective

To evaluate the impact of initiation of an enhanced recovery after cesarean delivery (ERAC) protocol for elective cesarean delivery (CD) on neonatal outcomes.

Study design

We performed a retrospective analysis of elective CD at ≥39 weeks gestational age between September 2014 and August 2018 at a single institution before and after ERAC protocol implementation. Our primary outcome was composite neonatal complication rate and secondary outcome was rate of breastfeeding. We performed univariate analyses to detect differences in outcomes between the pre-ERAC and post-ERAC groups.

Results

We included 362 neonates born via elective CD before (n = 135) and after (n = 227) ERAC implementation. The post-ERAC group experienced fewer composite neonatal complications (33.0% vs. 47.4%, p = 0.009) and greater breastfeeding rates (80.2% vs. 67.4%, p = 0.009) compared to the pre-ERAC group.

Conclusion

ERAC protocol implementation does not negatively impact neonates and may benefit both mother and baby.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

Buy

All prices are NET prices.

Fig. 1

References

  1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70:1–51.

    PubMed  Google Scholar 

  2. Enhanced Recovery After Cesarean (ERAC) Consensus Statement. Society of Obstetric Anesthesia and Perinatology. 2019. https://web.archive.org/web/20200507163918id_/https://soap.org/SOAP-Enhanced-Recovery-After-Cesarean-Consensus-Statement.pdf. Accessed 22 Oct 2021.

  3. Wilson RD, Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, et al. Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1). Am J Obstet. 2018;219:523.e1–5. https://doi.org/10.1016/j.ajog.2018.09.015.

    Article  Google Scholar 

  4. Caughey AB, Wood SL, Macones GA, Wrench IJ, Huang J, Norman M, et al. Guidelines for intraoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 2). Am J Obstet. 2018;219:533–44. https://doi.org/10.1016/j.ajog.2018.08.006.

    Article  Google Scholar 

  5. Bollag L, Lim G, Sultan P, Habib AS, Landau R, Zakowski M, et al. Society for obstetric anesthesia and perinatology: consensus statement and recommendations for enhanced recovery after cesarean. Anesth Analg. 2021;132:1362–77.

    Article  Google Scholar 

  6. Wrench IJ, Allison A, Galimberti A, Radley S, Wilson MJ. Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience. Int J Obstet Anesth. 2015;24:124–30. https://doi.org/10.1016/j.ijoa.2015.01.003.

    Article  CAS  PubMed  Google Scholar 

  7. Kleiman AM, Chisholm CA, Dixon AJ, Sariosek BM, Thiele RH, Hedrick TL, et al. Evaluation of the impact of enhanced recovery after surgery protocol implementation on maternal outcomes following elective cesarean delivery. Int J Obstet Anesth. 2020;43:39–46. https://doi.org/10.1016/j.ijoa.2019.08.004.

    Article  CAS  PubMed  Google Scholar 

  8. Malkin JD, Garber S, Broder MS, Keeler E. Infant mortality and early postpartum discharge. Obstet Gynecol. 2000;96:183–8. https://doi.org/10.1016/s0029-7844(00)00894-2.

    Article  CAS  PubMed  Google Scholar 

  9. Jones E, Stewart F, Taylor B, Davis PG, Brown SJ. Early postnatal discharge from hospital for healthy mothers and term infants. Cochrane Database Syst Rev. 2021;6:CD002958.

    PubMed  Google Scholar 

  10. Geller EJ, Wu JM, Jannelli ML, Nguyen TV, Visco AG. Neonatal outcomes associated with planned vaginal versus planned primary cesarean delivery. J Perinatol. 2010;30:258–64.

    Article  CAS  Google Scholar 

  11. Hussein SM, Salih Y, Rayis DA, Bilal JA, Adam I. Low neonatal blood glucose levels in cesarean-delivered term newborns at Khartoum Hospital, Sudan. Diagn Pathol. 2014;9:112 https://doi.org/10.1186/1746-1596-9-112.

  12. Gomez-Pomar E, Blubaugh R. The baby friendly hospital initiative and the ten steps for successful breastfeeding. A critical review of the literature. J Perinatol. 2018;38:623–32.

    Article  Google Scholar 

  13. ACOG committee opinion no. 761: Cesarean delivery on maternal request. Obstet Gynecol. 2019;133:133e73–7.

  14. Farhat R, Rajab M. Length of postnatal hospital stay in healthy newborns and re-hospitalization following early discharge. N Am J Med Sci. 2011;3:146–51.

    Article  Google Scholar 

  15. Thompson-Branch A, Havranek T. Neonatal Hypoglycemia. Pediatr Rev. 2017;38:147–57. https://doi.org/10.1542/pir.2016-0063.

    Article  PubMed  Google Scholar 

  16. Herstad L, Klungsøyr K, Skjærven R, Tanbo T, Forsén L, Åbyholm T, et al. Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy Childbirth. 2016;16:230. https://doi.org/10.1186/s12884-016-1028-3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Buie VC, Owings MF, DeFrances CJ, Golosinskiy A. National hospital discharge survey: 2006 annual summary. Vital Health Stat 13. 2010;168:1–79.

  18. Hobbs AJ, Mannion CA, McDonald SW, Brockway M, Tough SC. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth. 2016;16:90. https://doi.org/10.1186/s12884-016-0876-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. US Preventive Services Task Force. Primary care interventions to support breastfeeding: US preventive services task force recommendation statement. JAMA. 2016;316:1688–93. https://doi.org/10.1001/jama.2016.14697.

    Article  Google Scholar 

  20. Clark A, Litchfield K, Hannah S, Love C, Slade K, Lake K, et al. Pre-operative carbohydrate loading prior to elective caesarean delivery: a randomised controlled trial. Int J Obstet Anesth. 2021;45:21–7. https://doi.org/10.1016/j.ijoa.2020.10.008.

    Article  CAS  PubMed  Google Scholar 

  21. Ransjö-Arvidson AB, Matthiesen AS, Lilja G, Nissen E, Widström AM, Uvnäs-Moberg K. Maternal analgesia during labor disturbs newborn behavior: effects on breastfeeding, temperature, and crying. Birth. 2001;28:5–12. https://doi.org/10.1046/j.1523-536x.2001.00005.x.

    Article  PubMed  Google Scholar 

  22. Kujawa-Myles S, Noel-Weiss J, Dunn S, Peterson WE, Cotterman KJ. Maternal intravenous fluids and postpartum breast changes: a pilot observational study. Int Breastfeed J. 2015;10:18. https://doi.org/10.1186/s13006-015-0043-8.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bujang MA, Sa’at N, Sidik T, Joo LC. Sample size guidelines for logistic regression from observational studies with large population: emphasis on the accuracy between statistics and parameters based on real life clinical data. Malays J Med Sci. 2018;25:122–30.

    PubMed  PubMed Central  Google Scholar 

  24. Elias KM, Stone AB, McGinigle K, Tankou JI, Scott MJ, Fawcett WJ, et al. The reporting on ERAS compliance, outcomes, and elements research (RECOvER) checklist: a joint statement by the ERAS® and ERAS® USA societies. World J Surg. 2019;43:1–9.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Division of Perioperative Informatics (Department of Anesthesiology, University of Virginia, Charlottesville, VA) for their support and assistance with data collection.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA, USA

    Sunny S. Chiao, Jessica S. Sheeran, Katherine T. Forkin, Sarah N. Spangler, Ziyad O. Knio & Mohamed Tiouririne

  2. University of Virginia School of Medicine, University of Virginia, Charlottesville, VA, USA

    Khadija K. Razzaq

  3. Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA

    Ann L. Kellams

Authors
  1. Sunny S. Chiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Khadija K. Razzaq
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jessica S. Sheeran
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katherine T. Forkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah N. Spangler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ziyad O. Knio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ann L. Kellams
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohamed Tiouririne
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SSC and JSS conceptualized, designed, drafted, reviewed, and revised the paper. KKR collected data, drafted, reviewed, and revised the paper. KTF drafted, reviewed, and revised the paper. ZOK carried out the initial analyses, and reviewed and revised the paper. ALK reviewed and revised the paper. MT conceptualized and designed the study, reviewed, and revised the paper. SNS carried out the initial analyses, and reviewed and revised the paper. All authors approved the final paper as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sunny S. Chiao.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Chiao, S.S., Razzaq, K.K., Sheeran, J.S. et al. Effect of enhanced recovery after surgery for elective cesarean deliveries on neonatal outcomes. J Perinatol 42, 1283–1287 (2022). https://doi.org/10.1038/s41372-021-01309-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-021-01309-x

Search

Advanced search

Quick links