Department of Obstetrics & Gynecology, Washington University in St Louis, St. Louis, MO.
Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR.
Am J Obstet Gynecol. 2019 Sep;221(3):247.e1-247.e9. doi: 10.1016/j.ajog.2019.04.012. Epub 2019 Apr 14.
This Enhanced Recovery After Surgery Guideline for postoperative care in cesarean delivery will provide best practice, evidenced-based recommendations for postoperative care with primarily a maternal focus.
The pathway process for scheduled and unscheduled cesarean delivery for this Enhanced Recovery After Surgery cesarean delivery guideline will consider time from completion of cesarean delivery until maternal hospital discharge.
The literature search (1966-2017) used Embase and PubMed to search medical subject headings that included "Cesarean Section," "Cesarean Delivery," "Cesarean Section Delivery," and all postoperative Enhanced Recovery After Surgery items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses evaluated the quality of evidence, and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system as used and described in previous Enhanced Recovery After Surgery Guidelines.
The Enhanced Recovery After Surgery cesarean delivery guideline/pathway has created a pathway for postoperative care. Specifics include sham feeding, nausea and vomiting prevention, postoperative analgesia, nutritional care, glucose control, thromboembolism prophylaxis, early mobilization, urinary drainage, and discharge counseling. A number of elements of postoperative care of women who undergo cesarean delivery are recommended, based on the evidence.
As the Enhanced Recovery After Surgery cesarean delivery pathway (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, there will be an opportunity for focused and optimized areas of care and recommendations to be further enhanced.
本手术后康复加速康复外科剖宫产术后护理指南将提供以产妇为主要关注点的最佳实践和基于证据的推荐意见。
本加速康复外科剖宫产术后护理路径考虑了从剖宫产完成到产妇出院的时间，涵盖了计划性和非计划性剖宫产。
文献检索（1966-2017 年）使用 Embase 和 PubMed 搜索了包括“剖宫产”、“剖宫产分娩”、“剖宫产分娩”和所有术后加速康复外科项目的医学主题词。研究选择允许个体审查员筛选标题和摘要，以确定潜在相关文章。对每个单独的主题都考虑了荟萃分析、系统评价、随机对照研究、非随机对照研究、综述和病例系列。质量评估和数据分析评估了证据质量，根据先前的加速康复外科指南中使用和描述的推荐评估、评估、开发和评估系统评估了推荐意见。
加速康复外科剖宫产指南/路径为术后护理创建了一个路径。具体内容包括假饲、恶心和呕吐预防、术后镇痛、营养护理、血糖控制、血栓栓塞预防、早期活动、导尿和出院咨询。根据证据，推荐了一些剖宫产产妇术后护理的要素。
随着产科护理团队对加速康复外科剖宫产路径（要素/流程）的研究、实施、审核、评估和优化，将有机会进一步关注和优化护理领域，并提出更优的推荐意见。
