Enhanced recovery after cesarean (ERAC) protocols have improved postoperative outcomes. Which component of ERAC has the strongest evidence for reducing time to first ambulation and hospital stay?

• A Routine nasogastric tube placement and bowel rest for 24 hours postoperatively
• B Early oral hydration and alimentation (clear liquids 2–4 hours, regular diet 4–6 hours postcesarean) ✓
• C Intraoperative high-dose corticosteroids to reduce postoperative inflammation
• D Routine use of abdominal binders for 48 hours postoperatively

Explanation

Early feeding (clear fluids within 2–4 hours, regular diet by 4–6 hours) is one of the most evidence-supported components of ERAC, reducing ileus duration, hospital length of stay, and time to first ambulation without increasing nausea, vomiting, or wound complications. Cochrane reviews confirm early oral feeding improves patient satisfaction and outcomes. Nasogastric tubes are unnecessary after uncomplicated cesarean. Abdominal binders have limited evidence. Routine high-dose intraoperative steroids are not part of ERAC protocols.

Reference: Williams Obstetrics, 26th ed.

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Written and medically reviewed by the StethoPrep medical team.