Enhanced Recovery at Cesarean Birth to Improve Postoperative Outcomes and Reduce Postoperative Length of Stay

2016-11-08 09:23:22 | BioPortfolio


To determine whether women randomized to an enhanced recovery program will have improved postoperative outcomes including improved breastfeeding initiation and continuation, reduction in hospital length of stay without compromising patient satisfaction in comparison to standard postoperative recovery interventions.


The investigators hypothesize that an enhanced recovery program which includes several evidence based interventions at the time of cesarean birth in obstetrics will promote early ambulation, resumption of diet and initiation of breastfeeding, and reduce postoperative hospital length of stay.

Enhanced Recovery Protocol Components:

1. Provide preoperative education about the perioperative recovery experience including postoperative analgesia, thromboprophylaxis and breastfeeding education

2. Minimize preoperative starvation times

1. Moderate amount of clears up to 2 hours prior to anesthesia

2. Solid foods up to 6-8 hours prior to anesthesia

3. Prophylactic antibiotics

4. Venous thromboembolism prophylaxis (mechanical) initiated at the time of cesarean birth and continued postoperatively

5. Providing Duramorph at the time of regional anesthesia to reduce postoperative narcotic requirements

6. Chewing gum (Xylitol) to reduce postoperative ileus

7. Routine administration of Non-steroidal anti-inflammatory drug, Ketorolac, 15mg every 6 hours for 24 hours postoperatively to minimize postoperative narcotic use

8. Early initiation of feeding after cesarean, immediately for clears, 30 minutes for regular diet as tolerated

9. Early removal of urinary catheter (12 hours postoperatively)

10. Early removal of dressing (6 hours postoperatively)

11. Early mobilization at 12 hours after delivery

12. Early skin-to- skin/breastfeeding initiation

13. Early incentive spirometry

Currently, patients are encouraged to ambulate on the first post-operative day, but it is largely left up to the patient when to actually begin to ambulate. They are similarly offered a diet on the first postoperative day but are not encouraged to eat. Breastfeeding is more systematically encouraged early as part of Montefiore's effort to get baby friendly designation. And finally, patients are typically discharged on postoperative day number three unless complications arise in the newborn or the mother. As part of this study, patients in both the enhanced recovery and usual care group will be offered the opportunity to be discharged from the hospital on postoperative day number 2 if their recovery is progressing well and if they choose not to leave then they will be encouraged to return home on postoperative day number 3 according to the current standard of care.

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Supportive Care


Cesarean Section


Enhanced Recovery Protocol


Not yet recruiting


Montefiore Medical Center

Results (where available)

View Results


Published on BioPortfolio: 2016-11-08T09:23:22-0500

Clinical Trials [1672 Associated Clinical Trials listed on BioPortfolio]

Cesarean Section Via Enhanced Recovery

Enhanced Recovery After Surgery (ERAS) protocols have been proven to be very successful in specific patient populations. An example is with ERAS for colorectal surgery. ERAS protocols in t...

Appendectomy Versus no Appendectomy With Cesarean Section

Women having cesarean section will be divided into two groups - cesarean section alone or cesarean section with appendectomy. The purpose is to see if the appendectomy can be done without...

Optimization of the Healing Process of the Uterine Scar Tissue After Re-cesarean Section

This prospective, controlled, clinical, intervention study measures the number of uterine Cesarean section scars and median myometrial thickness of women who underwent two Cesarean section...

Bladder Flap Technique In Elective Cesarean Section

Cesarean section is a surgical procedure used to deliver one or more babies. cesarean section is usually performed when vaginal delivery will put the mother or child's health or life at ri...

Bladder Flap Versus Omission of Flap During Cesarean Section of Primiparous Women

Cesarean section is the most common surgical procedure performed on women. Over the years minor variations of each surgical step have been introduced, and cesarean sections are not standar...

PubMed Articles [10925 Associated PubMed Articles listed on BioPortfolio]


In recent years there is a growing local, as well as global, tendency among obstetricians to end labor by cesarean section in various circumstances. Current literature suggests that the leading factor...

External cephalic version after previous cesarean section: A cohort study of 100 consecutive attempts.

External cephalic version is commonly not performed in women with a previous cesarean section. Fear of uterine rupture and cesarean section in labor are prominent. The risks, however, of these are unc...

Vaginal Repair of Cesarean Section Scar Diverticula Diagnosed in Nonpregnant Women.

Cesarean section scar diverticulum (CSD) lead to many long-term complications. CSD is more prevalent in patients with a retroflexed uterus than in those with an anteflexed uterus. To estimate the asso...

Induction of labor after one previous Cesarean section in women with an unfavorable cervix: A retrospective cohort study.

Uterine rupture is a well-known but unusual complication in vaginal deliveries with a Cesarean section in the history. The risk of uterine rupture is at least two-fold when labor is induced. In Sweden...

Enhanced Recovery After Surgery (ERAS) Protocol, Pediatric Urologic Augmentation and Diversion Surgery Using Small Bowel.

Enhanced Recovery after Surgery protocols aim at improving recovery following urologic augmentation and diversion surgery. With regard to the positive experiences in adult patients, we aimed at evalua...

Medical and Biotech [MESH] Definitions

Delivery of an infant through the vagina in a female who has had a prior cesarean section.

Extraction of the fetus by abdominal hysterotomy anytime following a previous cesarean.

Extraction of the FETUS by means of abdominal HYSTEROTOMY.

A condition of the newborn marked by DYSPNEA with CYANOSIS, heralded by such prodromal signs as dilatation of the alae nasi, expiratory grunt, and retraction of the suprasternal notch or costal margins, mostly frequently occurring in premature infants, children of diabetic mothers, and infants delivered by cesarean section, and sometimes with no apparent predisposing cause.

Recovery from mental disorders and/or substance abuse. The process of change in which individuals improve their MENTAL HEALTH and wellness, live a self-directed life, and work to achieve their full potential.

More From BioPortfolio on "Enhanced Recovery at Cesarean Birth to Improve Postoperative Outcomes and Reduce Postoperative Length of Stay"

Quick Search


Relevant Topic

Women's Health
Women's Health - key topics include breast cancer, pregnancy, menopause, stroke Follow and track Women's Health News on BioPortfolio: Women's Health News RSS Women'...

Searches Linking to this Trial