Postoperative care in cesarean delivery: ERAS Guideline

The Enhanced Recovery After Surgery (ERAS) society has released guidelines on postoperative care in cesarean delivery. It provides best practice-based recommendations for postoperative care with a primarily maternal focus. The guideline is published in the American Journal of Obstetrics and Gynecology.

Chewing gum after cesarean section

• Gum chewing appears to be effective and at low risk. It may be a redundant policy if the treatment policy if early oral intake is being used. However, it should be used if delayed oral intake is planned.

Nausea and vomiting prevention

• Fluid preloading, the intravenous administration of ephedrine or phenylephrine, and lower limb compression are effective ways to reduce hypotension and intraoperative and postoperative nausea and vomiting.


• Antiemetic agents are effective for the prevention of postoperative nausea and vomiting during cesarean delivery. The multimodal approach should be applied for the treatment of postoperative nausea and vomiting.

Postoperative analgesia

• Multimodal analgesia that includes regular paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for enhanced recovery after cesarean delivery.

Perioperative nutritional care

• A regular diet within 2 hours after the cesarean delivery is recommended.

Perioperative glucose control

• Tight control of capillary glucose is recommended.

Prophylaxis against thromboembolism

• Pneumatic compression stockings should be used to prevent thromboembolism disease in women who undergo cesarean delivery.


• Heparin should not be used routinely for venous thromboembolism prophylaxis in patients after cesarean delivery.

Early post-cesarean delivery mobilization

• Early mobilization after cesarean delivery is recommended.

Post-cesarean delivery urinary drainage

• Urinary catheter should be removed immediately after cesarean delivery if placed during surgery.

Discharge counseling

• Standardized written discharge instructions should be used to facilitate discharge counseling.

"The ERAS cesarean delivery guideline/pathway has created a pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with 5 pre- elements (8 recommendations); 4 intraoperative elements (9 recommendations); 9 postoperative elements (11 recommendations, which are the focus of this document); and 1 neonatal element (6 recommendations)," wrote the authors.

"The maternity clinical care area has complex pathways, but there are increasing risk management factors that are related to obstetric comorbid medical, genetic, surgical, and lifestyle factors. More prospective and quality assessment/improvement research, evaluation, audit, and collaboration will be required for enhancement of the maternal and fetal health outcomes, quality, and safety," they concluded.

To read the guideline in detail follow the link: https://doi.org/10.1016/j.ajog.2019.04.012