الفهرس 
Physiological Intestinal Changes during PregnancyOnly 14 pages are availabe for public view
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Abstract
T
he number of caesarean sections performed each year is increasing at a dramatic rate all around the world. Postoperative care of these women is an important aspect and demands due attention. Hydration and nutrition are two essential components of postoperative care. Traditionally, postoperative hydration following caesarean section implied using 2–3 l of intravenous fluids in the first 24 h, thus providing for fluid lost during the surgery and the maintenance requirements (Horowitz 1997).
Traditionally postoperative oral intake is withheld until the return of bowel function. There has been concern that early oral intake would result in vomiting and sever paralytic ileus with subsequent aspiration pneumonia and wound dehiscence. However, supporting scientific evidence for this traditional practice is lacking and there are potential benefits from early postoperative oral intake (Charoenkwan et al., 2007).
However, caesarean section may not disrupt bowel function at all. The review found the evidence from trials does not justify withholding food and drink after uncomplicated caesarean section. There is some evidence that early food and drink might speed bowel recovery so drinking and eating again soon after caesarean section does not seem to cause women any problems, and may even speed recovery (Mangesi et al., 2002).
Misoprostol, an analog of prostaglandin that has uterotonic properties, has also been demonstrated to be beneficial at a high dose of 1200 μg per day for a week or more in the treatment of chronic refractory constipation (Soffer et al., 1994) (Riviere et al., 1991).
Although misoprostol is not used at such a high dose or for such a long duration in obstetric treatments, there are few studies on the possible affect that rectal dose might have on intestinal motility after surgery, which may favor early commencement of oral feeding and confer benefit on wound healing (Orji et al., 2009).
Several alternative approaches have emerged in recent years in an attempt to provide early return of bowel function. One such approach is the use of a prokinetic agent such as erythromycin, cisaperide or metoclopramide (Traut et al., 2008) (Kehlet, 2008).
The use of chewing gum has emerged as a further, new novel and simple strategy for preventing postoperative ileus. Several studies have reported on the beneficial effect of using chewing gum after surgery to limit the incidence (Purkayastha et al., 2008) (Abd-El-Maboud et al., 2009).
Aim of study:
This study aimed to compare To compare the effect of rectal misoprostol versus gum chewing on intestinal motility after elective caesarean section in patients with early oral feeding.
240 women were included in this study that was divided into three equal groups.
• Group M: (80 women) received 600 microgram rectal misoprostol immediately after the operation and took early oral feeding.
• Group G: (80 women) women began gum chewing 2 h postoperatively. Patients chewed sugarless gum (one stick) 3 times daily in the morning, afternoon, and evening. Each episode of gum chewing lasted 1 h except the initial one which lasted 15 min and took early oral feeding.
• Group C: (80 women) control group, took early oral feeding.
The selected women were subjected to the following:
• Proper full history was taken.
• General examination and abdominal examination.
• Trans-abdominal ultrasound for assessment of gestational age, placental site and fetal weight.
• All patients were observed intra-operatively for the degree of adhesion and categorized to it as mild, moderate and severe and also were observed for blood transfusion, administration of pethidine and febrile morbidity.
• Bowel sounds were heard by stethoscope every 2 hours for 48 hours.
• Passage of flatus, and stool.
• Adverse effects (fever, nausea, vomiting, diarrhea).
• Occurrence of post-partum hemorrhage.
• Febrile morbidity.
• Hospital stay.
• Amount of analgesia needed.
• The result of this study showed that there were no significant differences between the 3 groups with respect to mean maternal age, gestational age at delivery and parity.
• Women in the three groups had similar operative characteristics, including mean duration of surgery, type of anesthesia, mean degree of adhesions, and postoperative drugs used there were no significant differences in between the three groups.
• Compared with those who had gum chewing and control group, women in the misoprostol group had a significantly shorter mean interval to return of bowel sounds (3.25±1.207 hours versus 3.80±1.618 hours and 5.0±1.322 hours P0.040 and pb0.001); and a significantly shorter time until passage of flatus (6.18± 1.659 hours versus 7.34±2.439 hours and 9.65±2.886; p0.007 and Pb0.001) and passage of motion (14.83±5.165 hours versus 16.25±6443 and 20.67±7.406 hours; Pb0.001).
• There was no difference in the need for additional analgesic. Women in the misoprostol group were discharged earlier than those in the gum chewing and control groups (14.75±3.863 versus 16.68±4.471 and 21.6±6.486), with highly statistically significant difference (pb0.001).