Enhanced Recovery in Obstetrics Young and fit Less co-morbidity Motivated for early discharge Average hospital stay after delivery: Vaginal: 1-2 days Caesarean: 3-4 days ER CS: 1-2 days? NICE recommendation: 1 day after uncomplicated CS NICE Clinical Guideline 132. 2012 Not until 2013 Enhanced Recovery was described and debated in an editorial in relation to obstetric surgery. This is strange as the obstetric population should be suitable for fast recovery: A young and fit population with less co-morbidity and normally motivated for early discharge. The average stay after vaginal delivery is 1-2 days and after CS 3-4 days. National British guidelines recommend discharge after 1 day in uncomplicated cases. ullabang@rm.dk 1

Strategies for Enhanced Recovery after Caesarean Section Before Delivery Information Education: Analgesia, thromboprophylaxis, breastfeeding Day of Delivery Minimise starvation and thirst Intrathecal opioids Prophylactic antibiotics PONV and thrombo-prophylaxis An editorial in IJOA from 2013 has outlined the startegies for enhanced recovery after caesarean section. Many of the components were already an established part of the perioperative practice in many units and the programme therefore easier to implement. Information and education of the patient before delivery about pain therapy, tromboprophylaxis and breastfeeding. On the day of delivery starvation and thirst should be minimised. The patient should receive prophylactic antibiotics and prevention against nausea, vomiting and trombosis. After delivery the patient should be encouraged to early oral intake, and iv cannula and catheters should be removed early to fascilitate mobilisation. After Delivery Regular analgesia (multimodal) Early oral intake Early removal of catheter and iv cannula Early mobilisation ullabang@rm.dk

Enhanced Recovery after Caesarean Section 10 years’ experience ER programmes are easy to implement in obstetric patients: Improve maternal satisfaction Reduce hospital stay Do not increase maternal or neonatal readmission May reduce cost and morbidity Our enhanced programme reduced the postoperative use of morfin, increased patient satisfaction and the readmission rate did not increase. The programme has been adapted to all CS patients. ullabang@rm.dk