Wilson R Douglas, Nelson Gregg
Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary, Canada.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):8652-8665. doi: 10.1080/14767058.2021.1993816. Epub 2021 Oct 24.
Cesarean delivery is common, involves two patients, has numerous multi-disciplinary health care providers involved in the delivery management, but has variable levels of anesthesia and health services implementation for decreasing maternal hypothermia and the maternal and neonatal morbidity (and mortality). Limited implementation for either of the ERAS-CD or the ERAC guidelines, for inadvertent or preventive maternal hypothermia, is likely to be occurring on labor delivery floors. This Quality Improvement (QI) review focuses on cesarean delivery and maternal hypothermia.
This quality and safety initiative used SQUIRE 2.0 methodology and concurrent PubMed searches to identify systematic review, meta-analysis, topic directed studies, additional published cohorts in the topic area not included in SR/MA, limited case reports that had specific clinical outcomes related to maternal hypothermia and fetal effects.
Two quality and safety improvement guidelines have defined the hypothermia activity element differently, with ERAS-CD recommending to while ERAC recommending to . The peer-reviewed literature indicates that the knowledge associated with surgical hypothermia outcome is known but it is not implemented for maternal cesarean delivery care. Increased maternal-effect recognition, surveillance, triage, and evidenced-based protocol management is required for the maternal - neonatal dyad undergoing cesarean delivery for the clinical reduction/prevention of neonatal hypothermia that has proven evidence-based maternal morbidity and neonatal morbidity/mortality.
TEAM-based anesthesia, obstetrical, neonatology-pediatrics and nursing research collaboration is required through quality-safety-ERAS-ERAC directed processes. Healthcare system recognition and financial support is required for maternal-fetal-neonatal hypothermia prevention protocols implementation.
剖宫产很常见，涉及两名患者，有众多多学科医疗保健提供者参与分娩管理，但在降低产妇体温过低以及母婴发病率（和死亡率）方面，麻醉水平和医疗服务实施情况各不相同。分娩楼层可能在无意中或预防性地对加速康复剖宫产（ERAS - CD）或加速康复围产护理（ERAC）指南中的任何一项实施有限。这项质量改进（QI）审查聚焦于剖宫产和产妇体温过低。
这项质量与安全倡议采用了SQUIRE 2.0方法，并同时在PubMed上进行检索，以识别系统评价、荟萃分析、专题定向研究、该主题领域中未包含在系统评价/荟萃分析中的其他已发表队列、与产妇体温过低及胎儿影响相关的特定临床结局的有限病例报告。
两项质量与安全改进指南对体温过低活动要素的定义有所不同，ERAS - CD建议 ，而ERAC建议 。同行评审文献表明，与手术体温过低结局相关的知识是已知的，但在产妇剖宫产护理中并未得到实施。对于接受剖宫产的母婴二元组，为了临床减少/预防已证实有循证依据的产妇发病率和新生儿发病率/死亡率的新生儿体温过低，需要提高对产妇影响的认识、监测、分诊以及循证方案管理。
需要通过质量 - 安全 - ERAS - ERAC定向流程，开展基于团队的麻醉、产科、新生儿 - 儿科和护理研究合作。实施母婴 - 新生儿体温过低预防方案需要医疗保健系统的认可和资金支持。
