Early versus Late Oral Hydration after Cesarean Section; A Randomized Controlled Trial

Abstract

Caesarean section represents the most significant operative intervention in all of obstetrics. Its development and application has saved the lives of countless mothers and infants. On the other hand, its inappropriate use can be a direct avoidable cause of maternal mortality and morbidity. For these reasons, caesarean section probably represents the largest source of controversy and debate in modern obstetrics. The frequency with which it is carried out continues to rise. Ceasarean section is the most common major hospital surgical procedure performed in the industrialised world. Postoperative care and satisfaction of women who underwent a cesarean section is an important aspect and demands due attention, because they are different from other patients and don’t have just the role of a patient. Actually they are mothers that should care and breast feed their infant immediately after surgery. The objective of this study was to investigate prospectively the benefits and safety of early hydration on bowel movement after CS., (a prospective study that was conducted at Ain Shams Maternity).

Inclusion criteria Uncomplicated elective or emergency lower segment Caesarean section. Average blood loss during &after C.S (estimated blood loss not more than 1000cc)  Time of C.S is not above 90 minutes (from the opening of the abdomenal skin till closure of the skin).  Regional anaesthesia.  Primary or recurrent C.S. Exclusion criteria  Surgical complications (during C.S) esp.; intestinal injury.  Postpartum haemorrhage.  Medical disorders with pregnancy eg. hypertension, diabetes mellitus, gestational diabetes.  Factors that may increase the risk of postpartum haemorrhage as twins pregnancy, polyhydraminos and anaemia. The study included 247 patients. All patients had lower segment C.S and subdivided into 2 groups according to randomization scale. These two groups were group (A), early hydration which had 120 women who drank 100 ml clear unsweetened water after the end of operation with 1 hour and group (B), late hydration which had 227 women who started to drink water 6 hours after C.S. Both groups were subjected to the following: i. Detailed history. ii. Routine general and abdominal examinations (large fetal weight, blood pressure above 140\90). iii. Measurement of weight (kgs), height (m) to calculate the BMI. iv. Informed written consent from every woman participating in this study v. Caesarean section was performed by senior resident or registrar, who is competent to perform uncomplicated LSCS