Caughey Aaron B, Sultan Pervez, Monks David T, Sharawi Nadir, Bamber James, Panelli Danielle M, Sauro Khara M, Shah Prakeshkumar S, Muraca Giulia M, Metcalfe Amy, Wood Stephen L, Jago Caitlin A, Daly Sean, Blake Lindsay E A, Macones George A, Wilson R Douglas, Nelson Gregg
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Department of Anesthesiology, Critical Care, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA; Department of Targeted Intervention, University College London, London, UK.
Am J Obstet Gynecol. 2026 Jan;233(6S):S170-S183. doi: 10.1016/j.ajog.2025.02.040. Epub 2025 Apr 28.
Enhanced recovery after cesarean delivery protocols include evidence-based interventions which are designed to improve patient experience and maternal and neonatal outcomes, whilst reducing healthcare related costs. This is the first update to the Enhanced Recovery After Surgery Society guidelines for intraoperative care in cesarean delivery published in 2018. Interventions were selected based on expert consensus. An updated literature search was conducted in September 2024 involving the Embase, PubMed MEDLINE, EBSCO Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science databases. Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 Enhanced Recovery After Surgery Society guidelines publication, which evaluated each intraoperative enhanced recovery after cesarean delivery intervention, focusing on randomized clinical trials and large observational studies (≥800 patients) to maximize search feasibility and relevance. Following a review of the evidence, consensus was achieved surrounding the quality of evidence and strength of recommendation for each proposed intervention according to the Grading of Recommendations, Assessment, Development, and Evaluation system. The ten recommended enhanced recovery after cesarean delivery intraoperative intervention categories are: (i) use of personal support persons (very low evidence, strong recommendation); (ii) prophylactic antibiotics (moderate to high evidence, strong recommendation); (iii) abdominal and vaginal preparation (moderate evidence, strong recommendation); (iv) antiemetic prophylaxis (low evidence, strong recommendation); (v) prevention of spinal hypotension (low evidence, strong recommendation); (vi) maintenance of normothermia (moderate evidence, strong recommendation); (vii) maintenance of euvolemia (low evidence, strong recommendation), (viii) optimal use of uterotonics (moderate evidence, strong recommendation); (ix) multimodal analgesia (low evidence, strong recommendation); and (x) early initiation of skin-to-skin care (moderate evidence, strong recommendation). The ten recommended intraoperative interventions outlined above represent the best evidence to date and should be considered in the absence of contraindications in patients undergoing cesarean delivery to optimize patient recovery and outcomes.
剖宫产术后加速康复方案包括基于证据的干预措施，旨在改善患者体验以及母婴结局，同时降低医疗相关成本。这是2018年发布的外科术后加速康复学会剖宫产术中护理指南的首次更新。干预措施是基于专家共识选定的。2024年9月进行了更新的文献检索，涉及Embase、PubMed MEDLINE、EBSCO护理及相关健康文献累积索引、Scopus和科学网数据库。由医学图书馆员进行定向检索，以确定自2018年外科术后加速康复学会指南发布以来发表的相关文章，这些文章评估了每项剖宫产术中加速康复干预措施，重点关注随机临床试验和大型观察性研究（≥800例患者），以最大限度地提高检索的可行性和相关性。在对证据进行审查后，根据推荐分级、评估、制定和评价系统，就每项拟议干预措施的证据质量和推荐强度达成了共识。推荐的十项剖宫产术中加速康复干预类别为：（i）使用个人支持人员（证据质量极低，强烈推荐）；（ii）预防性使用抗生素（证据质量中等至高，强烈推荐）；（iii）腹部和阴道准备（证据质量中等，强烈推荐）；（iv）预防性使用止吐药（证据质量低，强烈推荐）；（v）预防脊髓低血压（证据质量低，强烈推荐）；（vi）维持正常体温（证据质量中等，强烈推荐）；（vii）维持血容量正常（证据质量低，强烈推荐）；（viii）优化宫缩剂的使用（证据质量中等，强烈推荐）；（ix）多模式镇痛（证据质量低，强烈推荐）；以及（x）早期开始皮肤接触护理（证据质量中等，强烈推荐）。上述十项推荐的术中干预措施代表了迄今为止的最佳证据，在无禁忌证的剖宫产患者中应予以考虑，以优化患者的恢复和结局。
