Guidelines for Antenatal and Preoperative care in Cesarean Delivery: Enhanced Recovery After Surgery Society Recommendations (Part 1)

Published:September 18, 2018DOI:
      This Enhanced Recovery After Surgery (ERAS) Guideline for perioperative care in cesarean delivery will provide best practice, evidenced-based, recommendations for preoperative, intraoperative, and postoperative phases with, primarily, a maternal focus. The focused pathway process for scheduled and unscheduled cesarean delivery for this ERAS Cesarean Delivery Guideline will consider from the time from decision to operate (starting with the 30–60 minutes before skin incision) to hospital discharge. The literature search (1966–2017) used Embase and PubMed to search medical subject headings that included “Cesarean Section,” “Cesarean Section,” “Cesarean Section Delivery” and all pre- and intraoperative ERAS items. Study selection allowed titles and abstracts to be screened by individual reviewers to identify potentially relevant articles. Metaanalyses, systematic reviews, randomized controlled studies, nonrandomized controlled studies, reviews, and case series were considered for each individual topic. Quality assessment and data analyses that evaluated the quality of evidence and recommendations were evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation system, as used and described in previous ERAS Guidelines. The ERAS Cesarean Delivery Guideline/Pathway has created a maternal focused pathway (for scheduled and unscheduled surgery starting from 30–60 minutes before skin incision to maternal discharge) with ERAS cesarean delivery consensus recommendations preoperative elements (anesthetic medications, fasting, carbohydrate supplementation, prophylactic antibiotics/skin preparation, ), intraoperative elements (anesthetic management, maternal hypothermia prevention, surgical technique, hysterotomy creation and closure, management of peritoneum, subcutaneous space, and skin closure), perioperative fluid management, and postoperative elements (chewing gum, management of nausea and vomiting, analgesia, timing of food intake, glucose management, antithrombotic prophylaxis, timing of ambulation, urinary management, and timing of maternal and neonate discharge). Limited topics for optimized care and for antenatal education and counselling and the immediate neonatal needs at delivery are discussed. Strong recommendations for element use were given for preoperative (antenatal education and counselling, use of antacids and histamine, H2 receptor antagonists, 2-hour fasting and small meal within 6 hours surgery, antimicrobial prophylaxis and skin preparation/chlorhexidine-alcohol), intraoperative (regional anesthesia, prevention of maternal hypothermia [forced warm air, warmed intravenous fluids, room temperature]), perioperative (fluid management for euvolemia and neonatal immediate care needs that include delayed cord clamping), and postoperative (fluid management to prevent nausea and vomiting, antiemetic use, analgesia with nonsteroidal antiinflammatory drugs/paracetamol, regular diet within 2 hours, tight capillary glucose control, pneumatic compression stocking for venous thromboembolism prophylaxis, immediate removal of urinary catheter). Recommendations against the element use were made for preoperative (maternal sedation, bowel preparation), intraoperative (neonatal oral suctioning or increased inspired oxygen), and postoperative (heparin should not be used routinely venous thromboembolism prophylaxis). Because these ERAS cesarean delivery pathway recommendations (elements/processes) are studied, implemented, audited, evaluated, and optimized by the maternity care teams, this will create an opportunity for the focused and optimized areas of care research with further enhanced care and recommendation.

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        • Steenhagen E.
        Enhanced recovery after surgery: It’s time to change practice!.
        Nutr Clin Pract. 2016; 31: 18-29
        • Elias K.M.
        Understanding enhanced recovery after surgery guidelines: An introductory approach.
        J Laparoendosc Adv Surg Tech A. 2017; 27: 871-875
        • Bisch S.P.
        • Wells T.
        • Gramlich L.
        • et al.
        Enhanced Recovery After Surgery (ERAS)in gynecologic oncology: System-wide implementation and audit leads to improved value and patient outcomes.
        Gynecol Oncol. 2018; 15: 117-123
        • Panda S.
        • Begley C.
        • Daly D.
        Clinicians’ views of factors influencing decision-making for caesarean section: a systematic review and metasynthesis of qualitative, quantitative and mixed methods studies.
        PLoS ONE. 2018; 13: e0200941
        • Nelson G.
        • Altman A.
        • Nick A.
        • et al.
        Guidelines for pre- and intraoperative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS) society recommendations – part I.
        Gynecol Oncol. 2016; 140: 313-322
        • Nelson G.
        • Altman A.
        • Nick A.
        • et al.
        Guidelines for postoperative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS) society recommendations – part II.
        Gynecol Oncol. 2016; 140: 323-332
        • Guyatt G.H.
        • Oxman A.D.
        • Vist G.E.
        • et al.
        GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.
        BMJ. 2008; 336: 924-926
        • Corso E.
        • Hind D.
        • Beever D.
        • et al.
        Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews.
        BMC Pregnancy Childbirth. 2017; 17: 91-101
        • Dahlke J.D.
        • Mendez-Figueroa H.
        • Rouse D.J.
        • Berghella V.
        • Baxter J.K.
        • Chauhan S.P.
        Evidence-based surgery for cesarean delivery: an updated systematic review.
        Am J Obstet Gynecol. 2013; 209: 294-306
        • Bettes B.A.
        • Coleman V.H.
        • Zinberg S.
        • et al.
        Cesarean delivery on maternal request: obstetrician-gynecologists’ knowledge, perception, and practice patterns.
        Obstet Gynecol. 2007; 109: 57-66
        • Dodd J.M.
        • Crowther C.A.
        • Grivell R.M.
        • Deussen A.R.
        Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth.
        Cochrane Database Syst Rev. 2017; 7: CD004906
        • Khunpradit S.
        • Tavender E.
        • Lumbiganon P.
        • Laopaiboon M.
        • Wasiak J.
        • Gruen R.L.
        Non-clinical interventions for reducing unnecessary caesarean section.
        Cochrane Database Syst Rev. 2011; 6: CD005528
        • Lavender T.
        • Hofmeyr G.J.
        • Neilson J.P.
        • Kingdon C.
        • Gyte G.M.
        Caesarean section for non-medical reasons at term.
        Cochrane Database Syst Rev. 2012; 3: CD004660
        • Blondon M.
        • Casini A.
        • Hoppe K.K.
        • Boehlen F.
        • Righini M.
        • Smith N.L.
        Risks of venous thromboembolism after cesarean sections: a meta-analysis.
        Chest. 2016; 150: 572-596
        • Hardy-Fairbanks A.J.
        • Lauria M.R.
        • Mackenzie T.
        • McCarthy Jr., M.
        Intensity and unpleasantness of pain following vaginal and cesarean delivery: a prospective evaluation.
        Birth. 2013; 40: 125-133
        • Jackson N.
        • Paterson-Brown S.
        Physical sequelae of caesarean section.
        Best Pract Res Clin Obstet Gynaecol. 2001; 15: 49-61
        • Smaill F.M.
        • Grivell R.M.
        Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section.
        Cochrane Database Syst Rev. 2014; 10: CD007482
        • Bonnar J.
        Massive obstetric haemorrhage.
        Baillieres Best Pract Res Clin Obstet Gynaecol. 2000; 14: 1-18
        • Colmorn L.B.
        • Krebs L.
        • Klungsoyr K.
        • et al.
        Mode of first delivery and severe maternal complications in the subsequent pregnancy.
        Acta Obstet Gynecol Scand. 2017; 96: 1053-1062
        • Lee Y.M.
        • D’Alton M.E.
        Cesarean delivery on maternal request: maternal and neonatal complications.
        Curr Opin Obstet Gynecol. 2008; 20: 597-601
        • Keag O.E.
        • Norman J.E.
        • Stock S.J.
        Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis.
        PLoS Med. 2018; 15: e1002494
        • Altman M.
        • Vanpee M.
        • Cnattingius S.
        • Norman M.
        Risk factors for acute respiratory morbidity in moderately preterm infants.
        Paediatr Perinat Epidemiol. 2013; 27: 172-181
        • Kamath B.D.
        • Todd J.K.
        • Glazner J.E.
        • Lezotte D.
        • Lynch A.M.
        Neonatal outcomes after elective cesarean delivery.
        Obstet Gynecol. 2009; 113: 1231-1238
        • Signore C.
        • Klebanoff M.
        Neonatal morbidity and mortality after elective cesarean delivery.
        Clin Perinatol. 2008; 35: 361-371
        • De Luca R.
        • Boulvain M.
        • Irion O.
        • Berner M.
        • Pfister R.E.
        Incidence of early neonatal mortality and morbidity after late-preterm and term cesarean delivery.
        Pediatrics. 2009; 123: e1064-e1071
        • Bager P.
        • Simonsen J.
        • Nielsen N.M.
        • Frisch M.
        Cesarean section and offspring’s risk of inflammatory bowel disease: a national cohort study.
        Inflamm Bowel Dis. 2012; 18: 857-862
        • Cardwell C.R.
        • Stene L.C.
        • Joner G.
        • et al.
        Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies.
        Diabetologia. 2008; 51: 726-735
        • Decker E.
        • Engelmann G.
        • Findeisen A.
        • et al.
        Cesarean delivery is associated with celiac disease but not inflammatory bowel disease in children.
        Pediatrics. 2010; 125: e1433-e1440
        • Huh S.Y.
        • Rifas-Shiman S.L.
        • Zera C.A.
        • et al.
        Delivery by caesarean section and risk of obesity in preschool age children: a prospective cohort study.
        Arch Dis Child. 2012; 97: 610-616
        • Sevelsted A.
        • Stokholm J.
        • Bonnelykke K.
        • Bisgaard H.
        Cesarean section and chronic immune disorders.
        Pediatrics. 2015; 135: e92-e98
        • Thavagnanam S.
        • Fleming J.
        • Bromley A.
        • Shields M.D.
        • Cardwell C.R.
        A meta-analysis of the association between caesarean section and childhood asthma.
        Clin Exp Allergy. 2008; 38: 629-633
        • Cho C.E.
        • Norman M.
        Cesarean section and development of the immune system in the offspring.
        Am J Obstet Gynecol. 2013; 208: 249-254
        • Lynch C.D.
        • Iams J.D.
        Diseases resulting from suboptimal immune function in offspring: is cesarean delivery itself really to blame?.
        Am J Obstet Gynecol. 2013; 208: 247-248
        • Romero R.
        • Korzeniewski S.J.
        Are infants born by elective cesarean delivery without labor at risk for developing immune disorders later in life?.
        Am J Obstet Gynecol. 2013; 208: 243-246
        • Fleisher J.
        • Khalifeh A.
        • Pettker C.
        • Berghella V.
        • Dabbish N.
        • MacKeen A.D.
        Patient satisfaction and cosmetic outcome in a RCT of cesarean skin closure.
        J Matern Fetal Med. 2018; ([Epub ahead of print])
        • Sood G.
        • Argani C.
        • Ghanem K.G.
        • Perl T.M.
        • Sheffield J.S.
        Infections complicating cesarean delivery.
        Curr Opin Infect Dis. 2018; 31: 368-376
        • Saeed K.B.M.
        • Greene R.A.
        • Corcoran P.
        • O’Neill S.M.
        Incidence of surgical site infection following cesarean section: a systematic review and meta-analysis protocol.
        BMJ Open. 2017; 7: e013037
        • Kolettis D.
        • Craigo S.
        Thromboprophylaxis in pregnancy.
        Obstet Gynecol Clin N Am. 2018; 45: 389-402
        • Villani M.
        • Ageno W.
        • Grandone E.
        • Dentali F.
        The prevention and treatment of venous thromboembolism in pregnancy.
        Expert Rev Cardiovasc Ther. 2017; 15: 397-402
        • Confidential enquiries into maternal deaths
        Why mothers die 1997-1999: the fifth report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.
        RCOG Press, London2001
        • Paranjothy S.
        • Griffiths J.D.
        • Broughton H.K.
        • Gyte G.M.L.
        • Brown H.C.
        • Thomas J.
        Interventions at caesarean section for reducing the risk of aspiration pneumonitis.
        Cochrane Database of Syst Rev. 2014; : CD004943
        • Najafi Anaraki A.
        • Mirzaei K.
        The effect of gabapentin versus intrathecal fentanyl on postoperative pain and morphine consumption in cesarean delivery: a prospective, randomized, double-blind study.
        Arch Gynecol Obstet. 2014; 290: 47-52
        • Moore A.
        • Costello J.
        • Wieczorek P.
        • Shah V.
        • Taddio A.
        • Carvalho J.C.
        Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial.
        Anesth Analg. 2011; 112: 167-173
        • Short J.
        • Downey K.
        • Bernstein P.
        • Shah V.
        • Carvalho J.C.
        A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial.
        Anesth Analg. 2012; 115: 1336-1342
        • Fabritius L.
        • Geisler A.
        • Petersen P.L.
        • et al.
        Gabapentin for postoperative pain management: a systematic review with meta-analyses and trial sequential analyses.
        Acta Anesthesiol Scand. 2016; 60: 1188-1208
        • Bavaro J.B.
        • Mendoza J.L.
        • McCarthy R.J.
        • Toledo P.
        • Bauchat J.R.
        Maternal sedation during scheduled versus unscheduled cesarean delivery: implications for skin-to-skin contact.
        Int J Obstet Anesth. 2016; 27: 17-24
        • Cree J.E.
        • Meyer J.
        • Hailey D.M.
        Diazepam in labour: its metabolism and effect on the clinical condition and thermogenesis of the newborn.
        BMJ. 1973; 4: 251-255
        • Whitelaw A.G.L.
        • Cummings A.J.
        • McFadyen I.R.
        Effect of maternal lorazepam on the neonate.
        BMJ. 1981; 282: 1106-1108
        • Walker K.J.
        • Smith A.F.
        Premedication for anxiety in adult day surgery.
        Cochrane Database Syst Rev. 2009; : CD002192
        • Dahabreh I.J.
        • Steele D.W.
        • Shah N.
        • Trikalinos T.A.
        Oral mechanical bowel preparation for colorectal surgery: systematic review and meta-analysis.
        Dis Colon Rectum. 2015; 58: 698-707
        • Arnold A.
        • Aitchison L.P.
        • Abbott J.
        Preoperative mechanical bowel preparation for abdominal, laparoscopic, and vaginal surgery: a systematic review.
        J Minim Invasive Gynecol. 2015; 22: 737-752
        • Lurie S.
        • Baider C.
        • Glickman H.
        • Golan A.
        • Sadan O.
        Are enemas given before cesarean section useful? A prospective randomized controlled study.
        Eur J Obstet Gynecol Reprod Biol. 2012; 163: 27-29
        • Maltby J.R.
        Fasting from midnight: the history behind the dogma.
        Best Pract Res Clin Anaesthesiol. 2006; 20: 363-378
        • Brady M.C.
        • Kinn S.
        • Stuart P.
        • Ness V.
        Preoperative fasting for adults to prevent perioperative complications.
        Cochrane Database Syst Rev. 2003; 4: CD004423
        • Smith I.
        • Kranke P.
        • Murat I.
        • et al.
        Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.
        Eur J Anaesthesiol. 2011; 28: 556-569
        • Somwanshi M.
        • Tripathi A.
        • Singh B.
        • Bajaj P.
        Effect of preoperative oral fluids on gastric volume and pH in postpartum patients.
        Middle East J Anaesthesiol. 1995; 13: 197-203
        • Lam K.K.
        • So H.Y.
        • Gin T.
        Gastric pH and volume after oral fluids in the postpartum patient.
        Can J Anaesth. 1993; 40: 218-221
        • American Society of Anesthesiologists
        Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters.
        Anesthesiology. 2011; 114: 495-511
        • Abdelhamid Y.A.
        • Chapman M.J.
        • Deane A.M.
        Review article peri-operative nutrition.
        Anaesthesia. 2016; 71: 9-18
        • Alfonsi P.
        • Slim K.
        • Chauvin M.
        • et al.
        French guidelines for enhanced recovery after elective colorectal surgery.
        J Visc Surg. 2014; 151: 65-79
        • Feldheiser A.
        • Aziz O.
        • Baldini G.
        • et al.
        Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: a consensus statement for anaesthesia practice.
        Acta Anaesthesiol Scand. 2016; 60: 289-334
        • Findlay J.M.
        • Gillies R.S.
        • Millo J.
        • Sgromo B.
        • Marshall R.E.
        • Maynard N.D.
        Enhanced recovery for esophagectomy: a systematic review and evidenced based guidelines.
        Ann Surg. 2014; 259: 413-431
        • Lambert E.
        • Carey S.
        Practice guideline recommendations on perioperative fasting: a systematic review.
        JPEN J Parenter Enteral Nutr. 2016; 40: 1158-1165
        • Mortensen K.
        • Nilsson M.
        • Slim K.
        • et al.
        Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS) Society recommendations.
        Br J Surg. 2014; 101: 1209-1229
        • Nelson G.
        • Altman A.D.
        • Nick A.
        • et al.
        Guidelines for pre- and intraoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations-Part 1.
        Gynecol Oncol. 2014; 140: 313-322
        • Smith M.D.
        • McCall J.
        • Plank L.
        • Herbison P.G.
        • Soop M.
        • Nygren J.
        Preoperative carbohydrate treatment for enhancing recovery after elective surgery.
        Cochrane Database Syst Rev. 2014; 8: CD009161
        • Ljungqvist O.
        • Thorell A.
        • Gutniak M.
        • Haggmark T.
        • Efendic S.
        Glucose infusion instead of preoperative fasting reduces postoperative insulin resistance.
        J Am Coll Surg. 1994; 178: 329-336
        • Bilku D.R.
        • Dennison A.R.
        • Hall T.C.
        • Metcalfe M.S.
        • Garcea G.
        Role of preoperative carbohydrate loading: a systematic review.
        Ann R Coll Surg Engl. 2014; 96: 15-22
        • Awad S.
        • Varadhan K.K.
        • Ljungqvist
        • Lobo D.N.
        A meta-analysis of randomized controlled trials on preoperative oral carbohydrate treatment in elective surgery.
        Clin Nutr. 2013; 32: 34-44
        • Lafflin M.R.
        • Shuai L.
        • Brisebois R.
        • Senior P.A.
        • Wang H.
        The use of a preoperative carbohydrate drink in patients with diabetes mellitus: a prospective, non-inferiority, cohort study.
        World J Surg. 2018; 42: 1965-1970
        • Malin G.L.
        • Bugg G.J.
        • Thornton J.
        • et al.
        Does oral carbohydrate supplementation improve labour outcome? A systematic review and individual patient data meta-analysis.
        BJOG. 2016; 123: 510-517
        • Orsini J.N.
        The essential Deming: leadership principles from the father of quality.
        McGraw Hill Professional, New York2012
      1. Cesarean delivery and peripartum hysterectomy.
        in: Cunningham F.G. Leveno K.J. Bloom S.L. Hauth J.C. Roude D.J. Spong C.Y. Williams obstetrics. 23rd ed. McGraw-Hill Medical, New York2010: 544-548
        • Alexander J.M.
        • Leveno K.J.
        • Hauth J.
        • et al.
        Fetal injury associated with cesarean delivery.
        Obstet Gynecol. 2006; 108: 885
        • Bloom S.L.
        • Leveno K.J.
        • Spong C.Y.
        • et al.
        Decision-to-incision times and maternal and fetal outcomes.
        Obstet Gynecol. 2006; 108: 6-11
        • Liu S.L.
        • Liston R.M.
        • Joseph K.S.
        • et al.
        Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.
        CMAJ. 2007; 176: 455-460
        • Villar J.
        • Carroli G.
        • Zavaleta N.
        • et al.
        Maternal and neonatal individual risks and benefits associated with cesarean delivery: Multicentre prospective study.
        BJM. 2007; 335: 1025
        • Burrows L.J.
        • Meyn L.A.
        • Weber A.M.
        • et al.
        Maternal morbidity associated with vaginal versus cesarean delivery.
        Obstet Gynecol. 2004; 103: 907-912
        • Silver R.M.
        • Landon M.B.
        • Rouse D.J.
        • et al.
        Maternal morbidity associated with multiple repeat cesarean deliveries.
        Obstet Gynecol. 2006; 107: 1226-1232
        • Lagrew D.C.
        • Low L.K.
        • Brennan R.
        • et al.
        National partnership for maternal safety: Consensus bundle on safe reduction of primary cesarean births: supporting intended vaginal births.
        Obstet Gynecol. 2018; 131: 503-513
        • Esposito P.
        • Dal Canton A.
        Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology.
        World J Nephrol. 2014; 3: 249-255

      Appendix References

      1. Alberta Perinatal Health Program. Available at: Accessed April 3, 2018.

        • World Health Organization (WHO)
        The Global Prevalence of Anaemia in 2011.
        WHO, Geneva2015
        • Weiss J.L.
        • Malon F.D.
        • Emig D.
        • et al.
        Obesity, obstetrical complications, and cesarean delivery rate: a population-based screening study. FASR-ER Research Consortium.
        Am J Obstet Gynecol. 2004; 190: 1091-1097
        • Stothard K.J.
        • Tennant P.W.
        • Bell R.
        • et al.
        Maternal overweight and obesity and the risk of congenital anomalies: a systematic review and meta-analysis.
        JAMA. 2009; 301: 636-650
        • Martin K.E.
        • Grivell R.M.
        • Yelland L.N.
        • Dodd J.M.
        The influence of maternal BMI and gestational diabetes on pregnancy outcome.
        Diabetes Res Clin Pract. 2015; 108: 508-513
        • Bramham K.
        • Parnell B.
        • Nelson-Piercy C.
        • Seed P.T.
        • Posaton L.
        • Chappell L.C.
        Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis.
        BMJ. 2014; 348: g2301
        • Metcalfe A.
        • Sabr Y.
        • Hutcheon J.A.
        • et al.
        Trends in obstetrical intervention and pregnancy outcomes of Canadian women with diabetes in pregnancy from 2004 to 2015.
        J Endocr Soc. 2017; 1: 1540-1549
        • Butwick A.J.
        • Walsh E.M.
        • Kuzniewicz
        • Li S.X.
        • Escobar G.J.
        Patterns and predictors of severe postpartum anemia after cesarean section.
        Transfusion. 2017; 57: 36-44
        • Drukker L.
        • Hants Y.
        • Farkash R.
        • Ruchlemer R.
        • Samueloff A.
        • Grisaru-Granovsky S.
        Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for cesarean section and adverse maternal and neonatal outcomes.
        Transfusion. 2015; 55: 2799-2806
        • Marchi J.
        • Berg M.
        • Dencker A.
        • Olander E.K.
        • Begley C.
        Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.
        Obes Rev. 2015; 16: 621-638
        • Dutton H.
        • Borengasser S.J.
        • Gaudet L.M.
        • Barbour L.A.
        • Keely E.J.
        Obesity in pregnancy optimizing outcomes for mom and baby.
        Med Clin N Am. 2018; 102: 87-106
        • Chen A.
        • Xie C.
        • Vuong A.M.
        • Wu E.
        • DeFranco E.A.
        Optimal gestational weight gain: prepregnancy BMI specific influences on adverse pregnancy and infant health outcomes.
        J Perinatal. 2017; 37: 369-374
        • Rasmussen K.M.
        • Catalano P.M.
        • Yaktine A.L.
        New guidelines for weight gain during pregnancy: what obstetrician/gynecologists should know.
        Curr Opin Obstet Gynecol. 2009; 21: 521-526
        • Overcash R.T.
        • Lacoursiere D.Y.
        The clinical approach to obesity in pregnancy.
        Clin Obstet Gynecol. 2014; 57: 485-500
        • Shirazian T.
        • Raghavan S.
        Obesity and pregnancy: Implications and management strategies for providers.
        Mt Sinai Med J. 2009; 76: 539-545
        • Satpathy H.K.
        • Fleming A.
        • Frey D.
        • Barsoom M.
        • Satpathy C.
        • Khandavala J.
        Maternal obesity and pregnancy.
        Postgrad Med. 2008; 120: E01-E09
        • Lamon A.M.
        • Habib A.S.
        Managing anesthesia for cesarean section on obese patients: current perspectives.
        Local Reg Anesth. 2016; 9: 45-57
        • Gaiser R.
        Anesthetic considerations in the obese parturient.
        Clin Obstet Gynecol. 2016; 59: 193-203
        • Friedman A.M.
        • Ananth C.V.
        Obstetrical venous thromboembolism: epidemiology and strategies for prophylaxis.
        Semin Perinatol. 2016; 40: 81-86
        • Kawakita T.
        • Landy H.J.
        Surgical site infections after cesarean delivery: epidemiology, prevention, and treatment.
        Matern Health Neonatol Perinatol. 2017; 3: 12
        • Grupper M.
        • Nicolau D.P.
        Obesity and skin and soft tissue infections: how to optimize antimicrobial usage for prevention and treatment.
        Curr Opin Infect Dis. 2017; 30: 180-191
        • Ayres-de-Campos D.
        Obesity and the challenges of caesarean delivery: prevention and management of would complications.
        Best Pract Res Clin Obstet Gynaecol. 2015; 29: 406-414
        • Aronow W.S.
        • Fridhman W.H.
        Implications of the new national guidelines for hypertension.
        Cardiol Rev. 2018; 26: 55-61
        • American College of Obstetricians, Gynecologists, Task Force on Hypertension in pregnancy
        Hypertension in pregnancy: report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy.
        Obstet Gynecol. 2013; 122: 1122-1131
        • Whelton P.K.
        • Carey R.M.
        • Casey D.E.
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines.
        J Am Soc Hypertens. 2018; 12: 579.e1-579.e73
        • Bateman B.T.
        • Bansil P.
        • Hernandez-Diaz S.
        • Mhyre J.M.
        • Callaghan W.M.
        • Kuklina E.V.
        Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions.
        Am J Obstet Gynecol. 2012; 206: e1-e8
        • Bramham K.
        • Parnell B.
        • Nelson-Piercy C.
        • Seed P.T.
        • Poston L.
        • Chappell L.C.
        Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis.
        BMJ. 2014; 348: g2301
        • Sava R.I.
        • March K.L.
        • Pepine C.J.
        Hypertension in pregnancy: taking cues from pathophysiology for clinical practice.
        Clin Cardiol. 2018; 41: 220-227
        • Sibai B.M.
        • Lindheimer M.
        • Hauth J.
        • et al.
        Risk factors for preeclampsia, abruptio placentae, and adverse neonatal outcomes among women with chronic hypertension: National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units.
        N Engl J Med. 1998; 339: 667-671
        • Schlembach D.
        • Homuth V.
        • Dechend R.
        Treating hypertension in pregnancy.
        Curr Hypertens Rep. 2015; 17: 63
      2. Hypertension in pregnancy: the management of hypertensive disorders during pregnancy: National Collaborating Centre for Women’s and Children’s Health (UK). RCOG Press, London2010
        • Abraham M.
        • Airamadhan S.
        • Iniguez C.
        • et al.
        A systematic review of maternal smoking during pregnancy and fetal measurements with meta-analysis.
        PLOS One. 2017; 12: e0170946
        • Hod M.
        • Kapur A.
        • Sacks D.A.
        • et al.
        The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: a pragmatic guide for diagnosis, management, and care.
        Int J Gynaecol Obstet. 2015; 131: S173-S211
        • Persson M.
        • Norman M.
        • Hanson U.
        Obstetric and perinatal outcomes in type 1 diabetic pregnancies.
        Diabetes Care. 2009; 32: 2003-2009
        • Balsells M.
        • Garcia-Patterson A.
        • Gich I.
        • Corcoy R.
        Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis.
        J Clin Endocrinol Metab. 2009; 94: 4284-4291
        • Gray S.G.
        • Sweeting A.N.
        • McGuire T.M.
        • Cohen N.
        • Ross G.P.
        • Little P.J.
        The changing environment of hyperglycaemia in pregnancy: Gestational diabetes and diabetes mellitus in pregnancy.
        J Diabetes. 2018; 10: 633-640
        • Schaefer-Graf U.
        • Napoli A.
        • Nolan C.J.
        Diabetes in pregnancy: a new decade of challenges ahead.
        Diabetologia. 2018; 61: 1012-1021
        • Langer O.
        • Yogev Y.
        • Most O.
        • Yexakis E.M.J.
        Gestational diabetes: the consequences of not treating.
        Am J Obstet Gynecol. 2005; 192: 989-997
        • American Diabetes Association
        Management of diabetes in pregnancy: standards of medical care in diabetes–2018.
        Diabetes Care. 2018; 41: S137-S143
        • Committee on Practice Bulletins: Obstetrics
        ACOG Practice Bulletin No. 190: gestational diabetes mellitus.
        Obstet Gynecol. 2018; 131: e49-e64
        • Denney J.M.
        • Quinn K.H.
        Gestational diabetes underpinning principles, surveillance, and management.
        Obstet Gynecol Clin N Am. 2018; 45: 299-314
        • Sexton H.
        • Heal C.
        • Banks J.
        • Braniff K.
        Impact of new diagnostic criteria foe gestational diabetes.
        J Obstet Gynaecol Res. 2018; 44: 425-431
        • Landon M.B.
        • Spong C.Y.
        • Thom E.
        • et al.
        A multicenter, randomized trial of treatment for mild gestational diabetes.
        N Engl J Med. 2009; 361: 1339-1348
        • Farrar D.
        • Simmonds M.
        • Bryant M.
        • et al.
        Treatments for gestational diabetes: a systematic review and meta-analysis.
        BMJ Open. 2017; 7: e015557
        • Berger H.
        • Gagnon R.
        • Sermer M.
        • et al.
        Diabetes in pregnancy.
        J Obstet Gynaecol Can. 2016; 38: 667-679
      3. World Health Organization. Hemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. World Health Organization. United Nations; 2011; WHO/NMH/NHD/MNM/11.1. Available at: Accessed June 12, 2017.

      4. NHS Blood Transfusion Committee. Patient blood management – an evidence-based approach to patient care. 2014. Available at: Accessed October 12, 2018.

        • Sun D.
        • McLeod A.
        • Gandhi S.
        • Malinowski A.K.
        • Shehata N.
        Anemia in pregnancy: a pragmatic approach.
        Obstet Gynecol Surv. 2017; 72: 730-736
        • Avni T.
        • Bieber A.
        • Grossman A.
        • Green H.
        • Leibovici L.
        • Gafter-Gvili A.
        The safety of intravenous iron preparations: systematic review and meta-analysis.
        Mayo Clin Proc. 2015; 90: 12-23
        • Figueiredo A.C.M.G.
        • Gomes-Filho I.S.
        • Silva R.B.
        • et al.
        Maternal anemia and low birth weight: a systematic review and meta-analysis.
        Nutrients. 2018; 10: e601
        • Levy A.
        • Fraser D.
        • Katz M.
        • Mazor M.
        • Sheiner E.
        Maternal anemia during pregnancy is an independent risk factor for low birthweight and preterm delivery.
        Eur J Obstet Gynecol Reprod Biol. 2005; 122: 182-186
        • Daru J.
        • Zamora J.
        • Fernandez-Felix B.M.
        • et al.
        Risk of maternal mortality with severe anaemia during pregnancy and post partum: a multilevel analysis.
        Lancet Glob Health. 2018; 6: e548-e554
        • Young M.F.
        Maternal anaemia and risk of mortality: a call for action.
        Lancet Glob Health. 2018; 6: e479-e480
        • Musallam K.M.
        • Tamim H.M.
        • Richards T.
        • et al.
        Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study.
        Lancet. 2011; 378: 1396-1407
        • US Department of Health and Human Services
        The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General.
        US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta2006
        • US Department of Health and Human Services
        The health consequences of smoking: a report of the Surgeon General.
        US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta2004
        • Veisani Y.
        • Jenabi E.
        • Delpisheh A.
        • Khazaei S.
        Effect of prenatal smoking cessation interventions on birth weight: meta-analysis.
        J Matern Fetal Neonatal Med. 2017; 19: 1-7
        • Kharkova O.A.
        • Grjibovski A.M.
        • Krettek A.
        • Nieboer E.
        • Odland J.O.
        Effect of smoking behavior before and during pregnancy on selected birth outcomes among singleton full-term pregnancy: a Murmansk County Birth Registry study.
        Int J Environ Res Public Health. 2017; 14: e867
        • Holbrook B.D.
        Review The effects of nicotine on human fetal development.
        Birth Defects Res. 2016; 108: 181-192
        • Leybovitz-Haleluya N.
        • Wainstock T.
        • Landau D.
        • Sheiner E.
        Maternal smoking during pregnancy and the risk of pediatric cardiovascular diseases of the offspring: a population-based cohort study with up to 18-years of follow up.
        Reprod Toxicol. 2018; 78: 69-74

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