Enhanced Recovery After Cesarean Section

Study Overview
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Brief Summary
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Measure compliance of the care of elective caesarean section with ERAS standards Measure the quality of recovery of women undergoing elective caesarean section

Detailed Description
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Caesarean section is one of most common surgeries worldwide and in Egypt. The Egyptian Demographic and Health Survey 2014 revealed a rising caesarean section rate . Many of these procedures are elective allowing time for preparation of the patient for surgery. Enhanced recovery after surgery (ERAS) is a multimodal, multi disciplinary, evidence based approach to surgical care with an ultimate goal to enhance recovery and improve maternal and neonatal outcome . This is done through optimizing multiple aspects of patient care to enhance recovery and so accelerate (facilitate) earlier discharge (decrease length of stay, decrease opioids use and encourage breastfeeding) . A comparative study in Egypt found ERAS to be effective in controlling perioperative gastrointestinal symptoms, pain control and encourages early ambulation with offering earlier resumption of intestinal motility, higher satisfaction and fewer days of admission . The clinical audit is a tool for assessing the compliance of current practice with the standard of care. In an audit, both process of care compliance and outcome of care can be measured to highlight gaps that need to be addressed by the institution . Enhanced Recovery After Surgery society issued Guidelines for elective Cesarean Section care . They include elements in preoperative, intraoperative and postoperative care. Compliance with each of these items was associated with improved maternal or neonatal outcome and a better recovery experience .

Official Title
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Clinical Audit on the Quality of Care of Elective Caesarean Section

Conditions
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Cesarean Section, Quality Of Care

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women undergoing elective caesarean section in the study period Exclusion Criteria: Women who cannot apply ERAS protocol emergency caesarean section anticipated surgical difficulty e.g. placenta previa/accrete, tumors obstructing lower uterine segment Severe maternal disease severe intraoperative bleeding or visceral injuries necessitating modification of postoperative care
Sexes Eligible for Study
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Female

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| First Audit cycle<br> | |
| Second Audit cycle<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the percentage of compliance of care with ERAS society guidelines | compliance of routinely provided care with ERAS society guidelines | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of recovery after elective caesarean section | better recovery experience with less length of stay at hospital | baseline |