Enhanced Recovery After

Surgery
(ERAS) in Caesarean Delivery
  Diperkenalkan Henrik Kehlet 1997 ( Denmark)
 Protokol ERAS pertama kali diterapkan pada
Sejarah bedah kolorektal,menghasilkan berkurangnya
lama perawatan,komplikasi perioperatif dan
ERAS meningkatkan kepuasan pasien tanpa
meningkatkan re-admisi
 Pada kelompok obstetri,protokol ERAS akhirnya
dipakai di Eropa yang belakangan juga menjadi
popular di Amerika Serikat sejak 2018
 Fast track surgery
  ERAS Guidelines in Caesarean Delivery menyediakan
panduan praktik berbasis bukti untuk fase pra, intra
dan pasca operasi
 ERAS CD Guidelines : dimulai sejak keputusan seksio
ERAS in sesarea sampai pasien pulang, termasuk layanan
neonatal
Cesarea  Komponen panduan ERAS CD meliputi 5 elemen pre
n operasi (8 rekomendasi); 4 elemen intraoperasi (9
Delivery rekomendasi);9 elemen pasca operasi (11 rekomendasi)
dan 1 elemen neonatal (6 rekomendasi)
Guidelines
for
Caesarean
Delivery
 KIE pre admisi tentang detil prosedur operasi, baik pada
operasi elektif maupun cito
Seksio sesarea atas permintaan pasien: tidak
direkomendasikan sebelum pasien mendapat informasi
Alur yang menyeluruh tentang manfaat dan risiko terhadap ibu
Antenatal dan bayi
Apendiks : Optimasi pada pasien + penyakit penyerta (obes,
hipertensi, DMG,anemia,merokok)
G e t t in g I n a n d o u t o f b e d

• l ie o n y o u r b a c k In t h e c e n t r e o f t h e b e d v v l t h b o t h k n e e s
ben t
Yo u r C e s a r e a n D e l iv e r y
• r o l l o v e r t o y o u r sid e v v l t h o u t t w i s t i n g t o o m u c h ( k e e p y o u r k n e e s
bent)

• v v lt h y o u r t o p a r m vv e l lIn f r o n t o r y o u , p u s h y o u r u p p e r b o d y ·
f o r w a r d a n d u p , a n d a l l o w y o u r le g s t o g o d o w n a t t h e s a m e
t im e
• r e m e m b e r t o k e e p b r e a t f ,l n g , k e e p y o u r k n e e s w e ll b e n t a n d
c o m e f o r w a r d a n d u p t o a s i t t in g p o s i t io n I n o n e s m o o t h
A G u i d e t o Y o u r B ir t h E x p e
a c t io n .
ie Vo n Vo i g t la n d e r W o H
 Obat
 Antasid dan antagonis reseptor H2
 Sedatif: jangan
 Tidak perlu persiapan usus
Alur Puasa
Preoperati 2 jam pre op cairan ‘jernih’
f Makanan ringan sampai 6 jam pre op
Suplementasi karbohidrat
Pasien nondiabetik boleh diberikan suplementasi KH
cair sampai 2 jam pre op
 Persiapan kulit dan antibiotika profilaksis
 Insisi pada operasi seksio tergolong bersih ( kelas 1)
atau bersih terkontaminasi ( kelas 2) atau kelas 3
( terkontamisasi)
 60 menit sebelum insisi kulit
Alur  In partu atau ketuban sudah pecah tambahkan
Intraoperati antibiotik
f  Chlorhexidine alcohol
 Cuci vagina dengan providone –iodine
 Anestesi Regional
Pencegahan Hipotermia
Pencegahan hipotermia penting dg monitor
Alur pasien , penggunaan perangkat penghangat
Intraoperati ( selimut, forced air warming, penghangat cairan
f IV dan menyesuaikan suhu kamar)
Hipotermia menyebabkan:
menggigil
infeksi luka
koagulopati, meningkatkan
perdarahan dan tranfusi
iskemia miokardial
gangguan metabolisme
obat hipotermia pada
neonatal
 Teknik seksio sesarea
Joel-Cohen approach perdarahan lebih
sedikit dan lebih cepat
Alur Hindari mengeluarkan uterus, mencuci
Intraoperati rongga perut
f Manajemen cairan perioperatif :
euvolemia
Delayed cord clamping saat • 30 sd 60 detik setelah bayi lahir
seksio sesarea • Meningkatkan kadar hemoglobin
dan cadangan zat besi bayi matur
• Prematur: menurunkan mortalitas
hingga 32%. Meningkatkan sirkulasi
transisional,volume eritrosit,
mengurangi kejadian tranfusi,
menurunkan enterokolitis nekrotik dan
perdarahan intrakranial bayi prematur
• Sedikit risiko hiperbilirubinemia
• Selama pandemi, pertimbangkan
risiko vs keuntungan
  Temperatur dipertahankan 36 5°C - 37°
 5C
Suction jalan nafas atau aspirasi gaster tidak
dikerjakan rutin
Alur neonatal
 Suplementasi dengan udara ruangan saja, karena
saat suplementasi dengan oksigen mungkin berisiko
persalinan  Pada setiap seksio sesarea, harus selalu tersedia
perangkat dan personel resusitasi neonatus
Does timing of urinary catheter removal after elective
cesarean section affects postoperative morbidity?: a
prospective randomized trial
Journal of Maternal-Fetal and Neonatal Medicine · January 2019 with 77 Reads
Article in

DOI: 10.1080/14767058.2019.1569619
Cite this publication

•
Nisreen Aref
•Taif University

Conclusion: Removal of the urinary catheter 6 h

postoperatively appears to be more advantageous
than early or late removal in cases of CS.
  Permen karet
 Pencegahan mual muntah
 Analgesia pasca operasi NSAID dan Parasetamol
 Diet biasa 2 jam pasca op
Alur  Kontrol gula darah peri op
 Profilaksis tromboemboli
pasca
 Mobilisasi dini
operatif
 Kateter dilepaskan se segera mungkin
 Konseling saat pulang kalau bisa tertulis dan
terstandarisasi
   Penerapan ERAS memerlukan
dukungan pembuat kebijakan, karena
sifatnya yang multidisiplin dan
multimodalitas
Kesimpula  Peran SpOG adalah dalam komunikasi,
n kendali komorbid,koordinasi,dan
evaluasi kepuasan
 EDITO R IALS AN D
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Delayed Versus Early Umbilical Cord
?
Clamping for Preterm Infants: A Systematic Article
Keywords
Review and Meta-Analysis Keywords
Fogarty, M.; Osborn, DA; Askie, L.; Seidler, A.L.; Hunte r, K.; Lui, K.; Simes, J.; Tarnow-Mordi, Neonatal Morbid ity and
w. Mortality
Author Informat ion 0
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(Am J Obstet Gynecol. 2018;218(1):1- 18)

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Delayed umbilical cord clamping may benefit preterm infants by
increasing the volume of b lood transferred to the neonate as well as
t es allowing time for physio logical trans it ion, which may result in Related
improved outcomes. The effects of delayed cord c lamping are Links
stil l unclear and an updated systematic review was needed. This Articles in PubMed by M.
; systematic review included randomized control led trials (RCTs) though Fogarty
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July 31, 2017 in order to evaluate t he effects of delayed clamping Fogarty
wit hout cord milking compa red to early clamping in reducing mortality Other a rticles i n this jou rnal by M.
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Enhanced recovery after surgery at cesarean delivery to reduce postoperative length of
stay: a randomized controlled trial
Nickolas C Teigen 1, Nicole Sahasrabudhe 2, Georgios Doulaveris 3, Xianhong Xie 4, Abdissa Negassa 4, Jeffrey Bernstein 5, Peter S Bernstein 3
Affiliations
•PMID: 31669738
•DOI: 10.1016/j.ajog.2019.10.009

Abstract
Objective: Our objective was to determine whether an enhanced recovery after surgery pathway at the time of cesarean birth would permit a reduction
in postoperative length of stay and improve postoperative patient satisfaction compared to standard perioperative care.

Albert Einstein College of Medicine, Bronx

Conclusion: Enhanced recovery after surgery at cesarean delivery was not associated with an increase in the
number of women discharged on postoperative day 2, but that may have been related to factors other than
patients' medical readiness for discharge. Evidence that enhanced recovery after surgery at cesarean delivery may
have the potential to improve outcomes such as day of discharge is suggested by the observed reduction in overall
postoperative length of stay, improved patient satisfaction, and an increase in breastfeeding rates. Even better
results may accrue with more provider and patient experience with enhanced recovery after surgery.