Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 13 , ISSUE 1 ( January-February, 2021 ) > List of Articles


Implementing Enhanced Recovery after Surgery in Obstetrics: A Lesson from the Nationwide Lockdown

Sangay Tshering, Namkha Dorji, Karma Lhaden

Keywords : Cesarean section, ERAS, Obstetrics

Citation Information : Tshering S, Dorji N, Lhaden K. Implementing Enhanced Recovery after Surgery in Obstetrics: A Lesson from the Nationwide Lockdown. J South Asian Feder Obs Gynae 2021; 13 (1):58-60.

DOI: 10.5005/jp-journals-10006-1860

License: CC BY-NC 4.0

Published Online: 00-02-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Enhanced recovery after surgery (ERAS) has proven benefits to the patients and the health system at large. Implementing ERAS in obstetrics has the potential to decongest the maternity ward by reducing postoperative hospital stay with safe maternal and neonatal outcomes. Extrapolating outcomes from studies in a similar setting and from our experience, we hereby discuss the possibility of implementing modified ERAS in obstetrics adapted to our resource-limited setting. Contextual-based consensus on modifications and implementation has to come from all stakeholders for a successful program.

PDF Share
  1. Mckay G, Parker M. LSHTM research online epidemics. Res Online 2016;38(1):81–95. DOI: 10.1080/01459740.2019.1609472.
  2. Dorji T, Wangmo K, Dorjey Y, et al. Indications and factors associated with cesarean section in Bhutan: a hospital‐based study. Int J Gynecol Obstet 2020. DOI: 10.1002/ijgo.13506.
  3. Leib H. Annual report 2019, JDWNRH Thimphu. AIMS Electron Electr Eng 2019;3(1):98–101. DOI: 10.3934/ElectrEng.2019.1.98.
  4. Stones W, Visser GHA, Theron G, et al. FIGO statement: staffing requirements for delivery care, with special reference to low- and middle-income countries. Int J Gynecol Obstet 2019;146(1):3–7. DOI: 10.1002/ijgo.12815.
  5. Wilson RD, Caughey AB, Wood SL, et al. Guidelines for antenatal and preoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 1). Am J Obstet Gynecol 2018;219(6):523.e1–523.e15. DOI: 10.1016/j.ajog.2018.09.015.
  6. Caughey AB, Wood SL, Macones GA, et al. Guidelines for intraoperative care in cesarean delivery: enhanced recovery after surgery society recommendations (part 2). Am J Obstet Gynecol 2018;219(6):533–544. DOI: 10.1016/j.ajog.2018.08.006.
  7. Macones GA, Caughey AB, Wood SL, et al. Guidelines for postoperative care in cesarean delivery: enhanced recovery after surgery (ERAS) society recommendations (part 3). Am J Obstet Gynecol 2019;221(3):247.e1–247.e9. DOI: 10.1016/j.ajog.2019.04.012.
  8. Entringer AP, Pinto MFT, Gomes MADSM. Costs analysis of hospital care for vaginal delivery and elective caesarean section for usual risk pregnant women in the Brazilian unified national health system. Cienc Saude Colet 2019;24(4):1527–1536. DOI: 10.1590/1413-81232018244.06962017.
  9. Bowden SJ, Dooley W, Hanrahan J, et al. Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge. BMJ Open Qual 2019;8(2):1–9. DOI: 10.1136/bmjoq-2018-000465.
  10. Bostanci Ergen E, Ozkaya E, Eser A, et al. Comparison of readmission rates between groups with early versus late discharge after vaginal or cesarean delivery: a retrospective analyzes of 14,460 cases. J Matern Neonatal Med 2018;31(10):1318–1322. DOI: 10.1080/14767058.2017.1315661.
  11. Brooten D, Roncoli M, Finkler S, et al. A randomized trial of early hospital discharge and home follow-up of women having cesarean birth. Obstet Gynecol 1994;84(5):832–838. Available at:
  12. Bhandoria GP, Bhandarkar P, Ahuja V, et al. Enhanced recovery after surgery (ERAS) in gynecologic oncology: an international survey of peri-operative practice. Int J Gynecol Cancer 2020;30(10):1471–1478. DOI: 10.1136/ijgc-2020-001683.
  13. Baluku M, Bajunirwe F, Ngonzi J, et al. A randomized controlled trial of enhanced recovery after surgery versus standard of care recovery for emergency cesarean deliveries at Mbarara Hospital, Uganda. Anesth Analg 2020;130(3):769–776. DOI: 10.1213/ANE.0000000000004495.
  14. Junaidi DS, Rajaratnam DA, Safoorah DA. A comparative study of enhanced recovery after surgery (ERAS) versus nonenhanced recovery after surgery (Non-ERAS) pathway for caesarean deliveries. Int J Clin Obstet Gynaecol 2020;4(5):93–95. DOI: 10.33545/gynae.2020.v4.i5b.688.
  15. Madhumala HR, Rohit S, Bharathi BM, et al. Comparison of ondansetron versus chewing gum for prevention of postoperative nausea and vomiting in patients undergoing elective LSCS: a randomised control trial. Indian J Clin Anaesth 2020;7(2):329–332. DOI: 10.18231/j.ijca.2020.059.
  16. Masood SN, Masood Y, Naim U, et al. A randomized comparative trial of early initiation of oral maternal feeding versus conventional oral feeding after cesarean delivery. Int J Gynecol Obstet 2014;126(2):115–119. DOI: 10.1016/j.ijgo.2014.02.023.
  17. Adams AM, Ahmed R, Shuvo TA, et al. Exploratory qualitative study to understand the underlying motivations and strategies of the private for-profit healthcare sector in urban Bangladesh. BMJ Open 2019;9(7):1–11. DOI: 10.1136/bmjopen-2019-032820.
  18. Neuman M, Alcock G, Azad K, et al. Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal. BMJ Open 2014;4(12):e005982. DOI: 10.1136/bmjopen-2014-005982.
  19. Das S, Alcock G, Azad K, et al. Institutional delivery in public and private sectors in South Asia: a comparative analysis of prospective data from four demographic surveillance sites. BMC Pregnancy Childbirth 2016;16(1):273. DOI: 10.1186/s12884-016-1069-7.
  20. Acharya J, Kaehler N, Marahatta SB, et al. Hidden costs of hospital based delivery from two tertiary hospitals in western Nepal. PLoS One 2016;11(6):e0157746. DOI: 10.1371/journal.pone.0157746.
  21. Haider MR, Rahman MM, Moinuddin M, et al. Ever-increasing caesarean section and its economic burden in Bangladesh. PLoS One 2018;13(12):e0208623. DOI: 10.1371/journal.pone.0208623.
  22. Stone AB, Yuan CT, Rosen MA, et al. Barriers to and facilitators of implementing enhanced recovery pathways using an implementation framework: a systematic review. JAMA Surg 2018;153(3):270–278. DOI: 10.1001/jamasurg.2017.5565.
  23. Hedderson M, Lee D, Hunt E, et al. Enhanced recovery after surgery to change process measures and reduce opioid use after cesarean delivery: a quality improvement initiative. Obstet Gynecol 2019;134(3):511–519. DOI: 10.1097/AOG.0000000000003406.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.