الفهرس 
Chronic Liver DiseaseOnly 14 pages are availabe for public view
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Abstract
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).