Gum chewing stimulates early return of bowel motility after caesarean section KHI Abd-El-Maeboud, MI Ibrahim, DAA Shalaby, MF Fikry Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt Correspondence: KHI Abd-El-Maeboud, Department of Obstetrics and Gynecology, Faculty of Medicine, Shams University, Abbasia, Cairo, Egypt. Email kabdelmaeboud@yahoo.com Accepted 9 April 2009. Published Online 12 June 2009. Objective To evaluate the efficacy and safety of postoperative gum chewing on the recovery of bowel motility after caesarean section. Design A randomised controlled study. Setting Faculty of Medicine, Ain Shams University, Egypt. Population A total of 200 pregnant women delivered by elective caesarean section (CS) under general anaesthesia. Methods Women were randomised into two groups; group A (93 women) who received one stick of sugarless gum for 15 minutes every 2 hours after surgery, and group B (107 women) had traditional management (oral intake of clear fluids allowed after passage of flatus and regular diet with the passage of bowel movement). Main outcome measures Time to first hearing of normal intestinal sounds, time to first flatus, time to first bowel movement and length of hospital stay. Results The mean duration of surgery was longer in group A (41.3 ± 7.5 versus 38.4 ± 8.1 minutes, P < 0.05). The mean postoperative time interval to first hearing of normal intestinal sounds (10.9 ± 2.7 versus 15.6 ± 3.7 hours), passage of flatus (17.9 ± 4.6 versus 24.4 ± 7.1 hours), defecation (21.1 ± 4.7 versus 30 ± 8.2 hours) and discharge from the hospital (40.8 ± 10.6 versus 50.5 ± 8.9 hours) were significantly shorter in group A (P < 0.001). Severe ileus occurred only in one woman belonging to group B. All patients in group A tolerated gum chewing beginning on the first postoperative day. Conclusion Gum chewing after CS is safe, well tolerated, and associated with rapid resumption of intestinal motility and shorter hospital stay; with potential impact on reducing the overall healthcare costs in case of routine implementation. Keywords Caesarean section, early oral feeding, gum chewing, ileus, postoperative. Please cite this paper as: Abd-El-Maeboud K, Ibrahim M, Shalaby D, Fikry M. Gum chewing stimulates early return of bowel motility after caesarean section. BJOG 2009;116:1334–1339. Introduction Following caesarean section (CS), the traditional practice is to withhold oral feeding until resolution of postoperative ileus (PI), often defined by passage of flatus and/or a bowel movement, with a physician-dictated regimen of gradual expansion of enteral feeding. This has been based upon concern about the possibility that early enteral feeding could exaggerate postoperative ileus, a pervasive problem- atic condition that ought to be minimised because of its possible serious consequences, 1,2 including significant post- operative morbidity, prolonged hospitalisation and increased healthcare costs. 2,3 The exact aetiology of ileus is unknown, but it is believed to be more common after lapa- rotomy and major abdominal surgical procedures that enter the peritoneal cavity, 1,2 notably those involving the bowel. 3–7 In fact many factors are believed to contrib- ute to the perpetuation of postoperative ileus, including intraoperative bowel manipulation, anaesthetic agents, peri- operative narcotics and postoperative sympathetic hyperac- tivity. 1–3 Comparative studies have reported earlier resolution of PI with similar rates of gastrointestinal complications after early and delayed feeding following caesarean section, 8–16 gynaecologic surgery 17–20 and colorectal surgery. 21–24 This dispels the classic teaching that postoperative patients may not have oral intake until the return of normal bowel function. However, some investigators reported that early feeding was associated with a high rate of intolerance 24,25 Trial registration number: ISRCTN86084115 Link to trial: www.controlled-trials.com/ISRCTN86084115 1334 ª 2009 The Authors Journal compilation ª RCOG 2009 BJOG An International Journal of Obstetrics and Gynaecology DOI: 10.1111/j.1471-0528.2009.02225.x www.bjog.org General obstetrics