The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial

Abstract

Objective: To endorse the impact of chewing gum on the intestinal functions’ restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD).

Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748).

Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p = .0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p = .0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use.

Conclusion: Chewing gum, within 2 h postoperatively, is a simple, safe and well-tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries.

Keywords:

• Cesarean delivery
• gum chewing
• intestinal motility
• maternal morbidity
• passage of flatus
• postoperative ileus
• enhanced recovery

Acknowledgements

Our acknowledgements are deserved to all nurses responsible in the postpartum ward of Armed Forces Hospitals Southern Region who were cooperative in the follow-up of our trial participants. Also, Dr. Nuzhat Amer, who passed away, was a great loss for our team. We hope this work will honor her soul and family.

Ethics approval

We started after receiving an appropriate approval from the local research ethics committee in Armed Forces Hospitals Southern Region. All women admitted to our trial were consented upon admission to use their data for research work without affecting their confidentiality. Also, the used records were anonymous for the interpreters.

Disclosure statement

No potential conflict of interest was reported by the authors.