Practice of enhanced recovery after cesarean delivery in resource-limited setting

Amelmasin Faris Ibrahem; Tadese Belayneh Melkie; Tesera Dereje Filatie; Biresaw Ayen Tegegne; Belete Muluadam Admassie

doi:10.1097/MS9.0000000000001571

Practice of enhanced recovery after cesarean delivery in resource-limited setting

Ann Med Surg (Lond). 2023 Nov 27;86(1):139-145. doi: 10.1097/MS9.0000000000001571. eCollection 2024 Jan.

Authors

Amelmasin Faris Ibrahem¹, Tadese Belayneh Melkie², Tesera Dereje Filatie², Biresaw Ayen Tegegne², Belete Muluadam Admassie²

Affiliations

¹ Department of Anesthesia, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa.
² Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, North Gondar, Ethiopia.

Abstract

Background: Caesarean section is one of the most common procedures and clinician faces dual challenges with feto-maternal morbidity and mortality after caesarean delivery. Enhanced recovery after caesarean delivery protocols might effectively reduce postoperative feto-maternal morbidity and mortality. Therefore, this study aimed to assess practice of enhanced recovery after caesarean delivery among parturients who underwent elective caesarean delivery.

Methods: A cross-sectional study design was conducted from March to June 2021 on 225 consecutive parturients scheduled for elective caesarean delivery. A semi-structured questionnaire which developed from Society of Obstetric Anesthesia and Perinatology, evidence-based recommendations regarding enhanced recovery after a caesarean (2020) to collect data. Data was collected through direct observation, reviewing the chart, and patient's interview. Data were entered and analyzed in SPSS version 20.

Result: Preoperative pathway; limit fasting interval (91%), haemoglobin screen and optimization (82%), and patient education (100%) found good Areas of practice Intraoperative pathway; administering postoperative nausea and vomiting prophylaxis (100%), fluid optimization (88%), neuraxial anaesthesia with a neuraxial opioid (91%), initiating multimodal analgesia (88%), optimal uterotonic administration (88%), delayed umbilical cord clamping (85%), and prophylactic antibiotic (100%) found areas with good areas of practice. Postoperative pathways; initiation of multimodal analgesia (74%) and early removal of the urinary catheter (62%) were found areas good areas of practice.

Conclusion and recommendation: The overall practice of enhanced recovery after caesarean delivery was below the target. The authors recommend that this comprehensive and specialized hospital administrator implement enhanced recovery after caesarean delivery protocol and give short-term training for health professionals' about the protocol.

Keywords: Caesarean delivery; enhanced recovery after caesarean.