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ERACS
Primaya Hospital Tangerang
2021
 Background
° An ERAC protocol aims to standardize the perioperative care of the
pregnant patient.
° By reducing variabilities in care and creating a specific evidence-
based care pathway, maternal and fetal outcomes can be improved
° Inherent to any enhanced recovery program is the interdisciplinary
approach and the inclusion of all parties: anesthesiology, obstetricians,
perinatologists, pediatricians, neonatologists, nursing, lactation
specialists, pharmacy, hospital administration, the patient and patients’
support systems
Cited from Society of Obstetric Anesthesia and Perinatology (SOAP): Enhanced Recovery After Cesarean
(ERAC)
Consensus Statement 5/23/19
 Goal
° Provide all women with evidence-based, patient-centered
care using a standardized, multidisciplinary approach that
optimizes recovery from cesarean delivery and improves
maternal and newborn outcomes
° Central to this goal is a culture of critically examining and
applying current knowledge through continual process
improvements and collaborations

Cited from Society of Obstetric Anesthesia and Perinatology (SOAP): Enhanced Recovery After Cesarean
(ERAC)
Consensus Statement 5/23/19
 Clinical Pathways
° In this guideline, focus on elements of the care pathway for
the preoperative, intraoperative and postoperative periods
° ERAC pathways have been developed for scheduled cesarean
delivery. However, many elements of the pathway can be
applied to non-scheduled cesarean delivery

Cited from Society of Obstetric Anesthesia and Perinatology (SOAP): Enhanced Recovery After Cesarean
(ERAC)
Consensus Statement 5/23/19
Feedback
 Antenatal
1. KIE pre admisi tentang detil prosedur operasi, baik pada
operasi elektif maupun cito
2. Seksio sesarea atas permintaan pasien: tidak
direkomendasikan sebelum pasien mendapat informasi yang
menyeluruh tentang manfaat dan risiko terhadap ibu dan
bayi
3. Apendiks : Optimasi pada pasien + penyakit penyerta (obes,
hipertensi, DMG,anemia,merokok)
 Perawatan
1. Untuk Pasien dengan Keadaan Umum Baik dan Operasi Target 45 menit,
2. Ruang Perawatan Pasien masuk malam sebelum op Tablet Ranitidin 150 mg QHS
3. Boleh makan makanan ringan rendah lemak sd 6 jam preop Tetap minum cairan jernih
( teh manis, jus tanpa serat, pocari) sd 2 jam pre op
4. Pagi mandi gosok daerah insisi dg sabun
5. Pagi 3 jam pre op tablet OMZ 40 mg, 2jam pre op PCT Drip 1000mg Cefalosporin
generasi II 1-2 gram. 30 mnt pre op
6. Bila in partu atau ketuban pecah ditambah Azithromisin 500 mg PO atau IV Asam
tranexamat 1 g 30 menit pre op
 Intra OP
1. Ruang operasi Pasien tetap harus hangat ( Blanket Warmer WAJIB )Anestesi spinal
2. Pencegahan nausea Dexamethason 5 mg IV dan Ondansentron 8mgIV  Sedatif:
Tidak direkomendasikan
3. Cuci kulit dg providone iodine
4. Jaga tetap euvolemia
5. Pemberian cairan infus tidak boleh dingin
6. Teknik operasi bebas
7. Delayed cord clamping 30-60 detik( setting OK bisa dihangatkan ), Skin to skin
contact ibu dan bayi, inisiasi menyusui dini.
8. Pencegahan nausea Ondansentron 8 mg Waktu jahit kulit
 Recovery
1. Ruang pulih Boleh minum cairan jernih 2 jam post op bisa makan
crackers
2. Analgesik kombinasi NSAID dan Paracetamol 3 x 1gram
3. Bila sudah bisa menggerakkan kaki, mobilisasi duduk di ranjang cek
TTV Duduk di tepi ranjang, cek TTV Menapak di lantai, cek TTV
Jalan ke kursi roda
4. Aff catether 6 - 8 jam post op
5. Mobilisasi diteruskan Rawat gabung
 Pertanyaan
1. Kriteria pasien yang dapat mengikuti prosedur?
Elektif! Tanpa komplikasi. ( ex Eklampsi )
2. Resiko ERACS ?
3. Jika OP Prolong dari 45 menit ? IC ke pasiennya jika
memang ada komplikasi.
4. Jika pasien dirawat lebih dari 1 hari ? IC ke pasien.
5. Gravid bebas. ( Post SC 3x masih bisa )