Enhanced Recovery After Emergency Cesarean Section: A Comparative Study Assessing Postoperative Recovery and Outcomes (ERAS)

Cesarean section (CS) remains one of the most common major surgical procedures worldwide, with emergency CS accounting for approximately 30% of cases. Emergency CS presents unique challenges including increased maternal stress, higher complication rates, and prolonged recovery compared to elective procedures . Enhanced Recovery After Surgery (ERAS) protocols offer a promising approach to optimize outcomes in this population.

Originally developed for colorectal surgery, ERAS principles have been successfully adapted to obstetric practice over the past decade. These evidence-based protocols emphasize multimodal interventions including preoperative counseling, optimized analgesia, early mobilization, and timely nutrition. In obstetrics, ERAS implementation has demonstrated reduced length of stay, decreased opioid use, and improved patient satisfaction for elective CS .

Application of ERAS to emergency CS requires special considerations due to the urgent nature of the procedure. Modified protocols focus on rapid preoperative assessment, regional anesthesia with intrathecal opioids, and immediate postoperative care initiation . Emerging evidence suggests these adaptations maintain benefits while accommodating time constraints . Key outcomes include reduced postoperative pain, earlier return of bowel function, and improved breastfeeding rates .

Current research demonstrates ERAS protocols can be safely implemented in emergency CS with proper staff training and institutional support . Ongoing studies continue to refine optimal practices, particularly regarding fluid management and thromboprophylaxis . As evidence accumulates, standardized guidelines for emergency CS ERAS pathways are expected to emerge .

Study Overview

• Status: Not yet recruiting
• Conditions: Cesarean Section Pain; ERAS

Detailed Description

The study is conducted on two phases. First phase study tools will be prepared. This is followed by the first and second audit cycles, preparatory phase is done to assess the intra-operative and post-operative care of women undergoing emergency cesarean section using the guidelines of Enhanced recovery after Surgery society. The quality of recovery score-11 translated into arabic. Permission is sought from adminstritive authorities.

First audit cycle : compliance with intraoperative measures is obtained by direct observation . post-operative information will be obtained by patient interview and record audit. The quiality of recovery will be assessed just before discharge using the quality of recovery score (ObsQoR-11).

Corrective action : gaps identified by first audit cycle is translated into defined corrrective measures.

• Study Type: Observational
• Enrollment (Estimated): 100

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Pregnant patients admitted to Woman's Health hospital, Assiut university labor ward and post-partum.

Description

Inclusion Criteria:

• singleton pregnancy who undergoing emergency cesarean section after 34weeks and accepting to be included in the study.

Exclusion Criteria:

• Pregnant woman who had previous rupture uterus.
• Other medical disorders as hypertensive disorder during pregnancy, cardiac disease.
• Intra-operative complications necessitating changes in post-operative care e.g. bowel injury, urinary tract injury.
• Hemodynamically unstable (post-partum hemorrhage)

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Enhanced Recovery After Surgery protocol for emergency cesarean section; Application of ERAS protocol delivered perioperatively and postoperatively as per institutional ERAS guidelines.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
assess the obstetric ObQOR11scrore at 12 hours and 24 hours post-operative	A data collection tool will be prepared for the study. After screening for eligibility, demographic factors, obstetric history. weight and gain, quality of previous cesarean scar if any, hemoglobin will be assessed for all patients. Observation of the outcomes will be recorded in the first phase of the study using a structured proforma and the Arabic version of ObQOR-11 score. Secondary outcomes measures include first oral intake, first abulation, first urination after catheter removal, passage of flatus and pain visual analog scale every 4 hours till discharge.	From enrollment till discharge after 24 hours.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Secondary outcome	Time to first oral intake	During hospital stay up to discharge, typically within 24-48 hours postoperative
Secondary outcome	Time to passage of flatus	During hospital stay up to discharge, typically within 24-48 hours postoperative
Secondary outcome	Time to first ambulation	During hospital stay up to discharge, typically within 24-48 hours postoperative
Secondary outcome	Time to first urination after catheter removal	During hospital stay up to discharge, typically within 24-48 hours postoperative
Secondary outcome	Pain visual analog scale (VAS) scores every 4 hours until discharge	During hospital stay up to discharge, typically within 24-48 hours postoperative

Collaborators and Investigators

• Sponsor: Assiut University

Study record dates

Study Major Dates

• Study Start (Estimated): December 1, 2025
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: November 14, 2025
• First Submitted That Met QC Criteria: November 19, 2025
• First Posted (Actual): November 21, 2025

Study Record Updates

• Last Update Posted (Actual): November 21, 2025
• Last Update Submitted That Met QC Criteria: November 19, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: ERAS; ERAS, emergency cs
• Other Study ID Numbers: ERAS after emergency cs

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No