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Objective To assess whether an early recovery after surgery (ERAS) pathway after scheduled cesarean delivery was associated with a reduction in postoperative length of stay compared with standard perioperative care. Methods This was a prospective pre- and post-intervention study. Women were included if they were between 18 and 45 years of age and delivered a singleton, term, non-anomalous fetus via scheduled cesarean delivery by a provider within an academic practice. The ERAS pathway consisted of 23 evidence-based components regarding preoperative, intraoperative, and postoperative care. The primary outcome was the rate of postoperative length of stay of 3 or more days. Secondary outcomes included total postoperative narcotic use, postoperative complications, 30-day hospital readmission rates, and quality of recovery questionnaire scores. Results A total of 116 women were included. There were no significant differences in patient characteristics between the pre- and post-implementation groups in the post-implementation group, surgery time was longer (78.3 ± 27.8 vs 59.1 ± 19.2 min, p < .001) and blood loss volume was higher (910.3 ± 405.1 vs 729.1 ± 202.0, p = .003), compared to pre-implementation group. An ERAS pathway was not associated in a significant reduction in postoperative length of stay of 3 or more days (70.7% vs 75.9%, p = .529). It was also not significantly associated with a difference in postoperative narcotic use, maximum pain score, transfusion, postoperative complications or hospital readmission rates. Conclusion An early recovery after surgery pathway after scheduled cesarean delivery was not associated with a reduction in postoperative length of stay or narcotic use, though the recovery scores were better after implementation. [ABSTRACT FROM AUTHOR]

Introduction To determine the impact of route of delivery on maternal outcomes among individuals who deliver preterm (before 37 weeks). Materials and methods This was a population-based retrospective cohort study using the U.S. vital statistics datasets on Period Linked Birth-Infant Death Data from 2014 to 2018. The study population was restricted to live births from women with non-anomalous singletons who delivered at 24–36 weeks of gestation. The main explanatory variable for this study was route of delivery, which was categorized as: (i) vaginal delivery, (ii) cesarean delivery with labor, and (iii) cesarean delivery without labor. The primary outcome was composite maternal adverse outcome, which encompassed any of the following: admission to the intensive care unit, maternal blood transfusion, uterine rupture, or unplanned hysterectomy. The results were presented as adjusted relative risk (aRR) with 95% confidence interval (CI). Results Over the study period 1,440,510 live births met the inclusion criteria, and the overall composite maternal adverse outcome was 14.38 per 1,000 live births. After multivariable adjustment, compared to women who underwent a vaginal delivery, the risk of composite maternal adverse outcome was higher in women who had a cesarean delivery with labor (aRR 3.70; 95% CI 3.52–3.90) and those who had a cesarean delivery without labor (aRR 4.79; 95% CI 4.59–4.98). Conclusion With preterm birth, cesarean delivery without labor has higher rate of composite maternal morbidity than cesarean during labor or vaginal delivery. [ABSTRACT FROM AUTHOR]

Objective: To compare the rate of neonatal hypoglycemia among newborns delivered by individuals with Type 2 diabetes mellitus (T2DM) in two clinical scenarios: who attempted vaginal delivery vs. had a planned cesarean delivery (CD); who had intrapartum insulin infusion vs. who did not. Methods: This was a retrospective cohort study of individuals with insulin-treated T2DM who had non-anomalous singleton pregnancy and delivered at a single tertiary center (March 2012 and May 2018). Individuals with chronic renal failure, proliferative retinopathy, or major congenital anomalies were excluded. The primary outcome was neonatal hypoglycemia (blood glucose < 40 mg/dl <24 h of age or < 50 mg/dl >24 h of age). Secondary outcomes included neonatal outcomes. Multivariable Poisson regression models with robust error variance were used to examine the association between groups and the primary outcome. Adjusted relative risk (aRR) and 95% confidence intervals (CI) were calculated. Results: Of 233 individuals with T2DM, 215 (92.2%) met the inclusion criteria, of whom 95 (44%) attempted vaginal delivery and 120 (56%) had a planned CD. Individuals who labored had a higher gestational age at delivery (36.6 vs. 35.8 weeks, p = .005), and higher blood glucose levels upon admission (125 vs 103, p < .001) compared to those with a planned CD. After adjustment for potential confounders, there was no difference in risk of neonatal hypoglycemia between the groups (41.2 vs 44.1%, aRR 1.05, 95% CI = 0.75-1.45). Among those who attempted vaginal delivery, 34 (35.8%) required insulin infusion. There was no difference in the risk of neonatal hypoglycemia (aRR = 0.79, 95% CI = 0.45-1.37) between newborns delivered by individuals who required insulin infusion and those who did not. Conclusion: Over 40% of newborns delivered by individuals with insulin-dependent T2DM had hypoglycemia; however, there was no significant difference in the risk of hypoglycemia, irrespective of the route of delivery and the use of insulin infusion. [ABSTRACT FROM AUTHOR]