This study aims to evaluate the impact of Enhanced Recovery After Surgery protocols on maternal outcomes patient satisfaction and length of hospital stay following cesarean delivery in women with placenta previa. Women scheduled for elective cesarean delivery for placenta previa will be managed either with a standardized ERAS pathway or with conventional routine perioperative care.
Placenta previa is associated with significant maternal morbidity and prolonged hospitalization. Enhanced Recovery After Surgery pathways include patient education preoperative fasting optimization multimodal analgesia early oral intake early mobilization and early urinary catheter removal. This prospective study will include women with singleton pregnancy and sonographic diagnosis of placenta previa scheduled for elective cesarean delivery at Assiut University Hospital. Group A will receive ERAS pathway and Group B will receive conventional care. Outcomes including length of hospital stay postoperative pain time to ambulation time to oral intake and patient satisfaction will be compared.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
100
Standardized ERAS pathway for cesarean delivery including preoperative counseling, clear fluids allowed up to 2 hours and solid food fasting for 6 hours, optimization of hemoglobin, multimodal analgesia with scheduled acetaminophen and nonsteroidal anti-inflammatory drugs with limited opioids, prophylaxis for postoperative nausea and vomiting, early oral fluid and solid intake, early mobilization with sitting and standing and ambulation within 6 to 12 hours, early Foley catheter removal within 12 hours when clinically feasible, and standardized discharge planning. This intervention is applied only to the Experimental Arm.
Routine conventional perioperative care currently practiced at Assiut University Hospital including traditional preoperative fasting, standard analgesia, usual timing of oral intake, mobilization and urinary catheter removal according to physician preference.
Length of hospital stay
Duration of hospital stay measured in hours from end of cesarean delivery to hospital discharge
Time frame: Up to 7 days
Postoperative pain score at 6 hours
Pain score assessed using 0 to 10 Visual Analogue Scale with 0 indicating no pain and 10 indicating worst imaginable pain with higher scores indicating worse pain
Time frame: At 6 hours after surgery
Postoperative pain score at 24 hours
Pain score assessed using 0 to 10 Visual Analogue Scale with 0 indicating no pain and 10 indicating worst imaginable pain with higher scores indicating worse pain
Time frame: At 24 hours after surgery
Time to first ambulation
Time in hours from end of surgery to first ambulation
Time frame: Up to 48 hours
Time to first oral intake
Time in hours from end of surgery to first oral fluid intake
Time frame: Up to 24 hours
Time to urinary catheter removal
Time in hours from end of surgery to Foley catheter removal
Time frame: Up to 48 hours
Postpartum hemorrhage
Number of participants who develop postpartum hemorrhage with blood loss greater than 1000 milliliters
Time frame: Up to 24 hours
Requirement for blood transfusion
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Number of participants who require packed red blood cells transfusion
Time frame: Up to 7 days
Patient satisfaction score
Score on the Quality of Recovery-15 questionnaire scale ranges from 0 to 150 with higher scores indicating better recovery and satisfaction
Time frame: At 24 hours after surgery