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. 2002;2002(3):CD003516.
doi: 10.1002/14651858.CD003516.

Early compared with delayed oral fluids and food after caesarean section

L Mangesi  1 , G J Hofmeyr
Affiliations

Early compared with delayed oral fluids and food after caesarean section

L Mangesi et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: It is customary for fluids and/or food to be withheld for a period of time after abdominal operations. After caesarean section, practices vary considerably. These discrepancies raise concern as to the bases of different practices.

Objectives: To assess the effect of early versus delayed introduction of fluids and/or food after caesarean section.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (January 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001).

Selection criteria: Clinical trials with random allocation comparing early versus delayed oral fluids and/or food after caesarean section were considered. The participants were women within the first 24 hours after caesarean section. The criteria for 'early' feeding were as defined by the individual trial authors - usually within six to eight hours of surgery.

Data collection and analysis: Trials considered were evaluated for methodological quality and appropriateness for inclusion. For dichotomous data, relative risks and 95% confidence intervals were calculated. Continuous data were compared using weighted mean difference and 95% confidence interval. Sub-group analyses were performed for general anaesthesia, regional analgesia and where anaesthesia was mixed or undefined.

Main results: Of 12 studies considered, six were included in this review. Four were excluded and two are pending further information. The methodological quality of the studies was variable. Only one to three studies contributed usable data to each outcome. Three studies were limited to surgery under regional analgesia, while three included both regional analgesia and general anaesthesia. Early oral fluids or food were associated with: reduced time to first food intake (one study, 118 women; the intervention was a slush diet and food was introduced according to clinical parameters; weighted mean difference -7.20 hours, 95% confidence interval -13.26 to -1.14); reduced time to return of bowel sounds (one study, 118 women; -4.30 hours, -6.78 to -1.82); reduced postoperative hospital stay following surgery under regional analgesia (two studies, 220 women; -0.75 days, -1.37 to -0.12 - random effects model); and a trend to reduced abdominal distension (three studies, 369 women; relative risk 0.78, 95% confidence interval 0.55 to 1.11). No significant differences were identified with respect to nausea, vomiting, time to bowel action/ passing flatus, paralytic ileus and number of analgesic doses.

Reviewer's conclusions: There was no evidence from the limited randomised trials reviewed, to justify a policy of withholding oral fluids after uncomplicated caesarean section. Further research is justified.

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Conflict of interest statement

None known.

Figures

1.2
1.2. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 2 Time to first food (hours).
1.3
1.3. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 3 Postoperative nausea.
1.4
1.4. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 4 Postoperative vomiting.
1.5
1.5. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 5 Time to return of bowel sounds (hours).
1.6
1.6. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 6 Time to passing flatus (hours).
1.7
1.7. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 7 Time to bowel action (hours).
1.8
1.8. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 8 Abdominal distension.
1.9
1.9. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 9 Paralytic ileus (as defined by trial authors).
1.13
1.13. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 13 Analgesic doses postoperatively.
1.14
1.14. Analysis
Comparison 1 Eary versus delayed fluids and/or food, Outcome 14 Postoperative hospital stay (days).
See this image and copyright information in PMC

References

References to studies included in this review

Burrows 1995 {published data only}
    1. Burrows WR, Gingo AJ, Rose SM, Zwick SI, Kosty DL, Dierker LJ, et al. Safety and efficacy of early post operative solid food consumption after caesarean section. Journal of Reproductive Medicine 1995;40:463‐7. - PubMed
Guedj 1991 {published data only}
    1. Guedj P, Eldor J, Stark M. Immediate post operative oral rehydration after caesarean section. Asia‐Oceania Journal of Obstetrics and Gynaecology 1991;17(2):125‐9. - PubMed
Kramer 1996 {published data only}
    1. Kramer RL, Someren JK, Qualls CR, Curet LB. Postoperative management of cesarean patients: the effect of immediate feeding on the incidence of ileus. Obstetrics and Gynecology 1996;88:29‐32. - PubMed
Patolia 2001 {published data only}
    1. Hilliard R, Patolia DS, Toy EC, Baker B. Early feeding after cesarean delivery. Obstetrics and Gynecology 2000;95(4 Suppl):44S. - PubMed
    1. Patolia DS, Hilliard RLM, Toy EC, Baker B. Early feeding after cesarean: randomized trial. Obstetrics and Gynecology 2001;98(1):113‐6. - PubMed
Pruitt 2000 {published data only}
    1. Pruitt B, Brumfield C, Owen J, Savage K, Cliver S. Early feeding after cesarean: a randomized clinical trial [abstract]. Obstetrics and Gynecology 2000;95(4 Suppl):64S.
Weinstein 1993 {published data only}
    1. Weinstein L, Dyne PL, Duerbeck NB. The PROEF diet ‐ a new postoperative regimen for oral early feeding. American Journal of Obstetrics and Gynecology 1993;168:128‐31. - PubMed
    1. Weinstein L, Dyne PL, Duerbeck NB. The PROEF diet ‐ a new postoperative regimen for oral early feeding. Surgery Gynecology and Obstetrics 1993;177:29. - PubMed

References to studies excluded from this review

Al‐Takroni 1999 {published data only}
    1. Al‐Takroni AMB, Parvathi CK, Mendis KBL, Hassan S, Qunaibi AM. Early oral intake after caesarean section performed under general anaesthesia. Journal of Obstetrics and Gynaecology 1999;19(1):34‐7. - PubMed
Benzineb 1995 {published data only}
    1. Benzineb N, Slim MN, Masmoudi A, Ben Taieb A, Sfar R. The value of realimentation following cesarean section. Revue Francaise de Gynecologie et d Obstetrique 1995;90:281‐5. - PubMed
Soriano 1996 {published data only}
    1. Soriano D, Dulitzki M, Keidar N, Barkai G, Maschiach S, Seidman DS. Early oral feeding after cesarean section. Obstetrics and Gynecology 1996;87:1006‐8. - PubMed
Sunshine 1997 {published data only}
    1. Sunshine A, Olsen N, Zighelboim I, Wajdula J. A food interaction study of bromfenac, naproxen sodium and placebo in caesarean section patients. Clinical Pharmacology and Therapeutics 1997;61:PIII‐9. - PubMed

References to studies awaiting assessment

Al‐Takroni 1997 {published data only}
    1. Al‐Takroni A, Ansari N. Early oral intake after caesarean section (CS) performed under general anaesthesia. Acta Obstetricia et Gynecologica Scandinavica 1997;76(Suppl 167:5):14.
Farine 2001 {published data only}
    1. Farine D, Noorwali F, Seaward G, Lubin M, Salenieks M, Karkanis S. Comparison of early and delayed feeding post‐cesarean delivery [abstract]. American Journal of Obstetrics and Gynecology 2001;184(1):S:194.

Additional references

Bennett 1999
    1. Bennett VR, Brown LK. Myles textbook for midwives. 13th Edition. Toronto: Churchill Livingstone, 1999.
Clarke 2000
    1. Clarke M, Oxman AD, editors. Cochrane Reviewers’ Handbook 4.1 [updated June 2000]. In: Review Manager (RevMan) [Computer program]. Version 4.1. Oxford, England: The Cochrane Collaboration, 2000.
Gabbe 1996
    1. Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: normal and problem pregnancies. 3rd Edition. New York: Churchill Livingstone, 1996.
Knuppel 1993
    1. Knuppel RA, Drukker JE. High risk pregnancy: a team approach. 2nd Edition. London: WB Saunders Company, 1993.
RevMan 2000 [Computer program]
    1. The Cochrane Collaboration. Review Manager (RevMan). Version 4.1 for Windows. Oxford, England: The Cochrane Collaboration, 2000.
Sellers 1993
    1. Sellers PM. Midwifery. Vol. 2, Kenwyn: Juta & co. Ltd, 1993.
Sweet 1997
    1. Sweet BR, Tiran D. Mayes' Midwifery. 12th Edition. London: Bailliere Tindall, 1997.

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