Early oral intake and gastrointestinal function after cesarean delivery: a systematic review and meta-analysis.

Abstract

To evaluate whether early oral intake after cesarean delivery has an effect on gastrointestinal outcomes during postpartum recovery. Electronic searches of published studies between 1980 and 2011 were conducted using PubMed, Medline, CINAHL, ClinicalTrials.gov, and Airiti databases. Randomized controlled trials (RCTs) and nonrandomized trials were included. Data were extracted in a systematic manner and the quality of each study was appraised independently by two reviewers. Meta-analyses were conducted only for RCTs using the RevMan5. Seventeen studies met eligible criteria and were retrieved, including 14 RCTs and three non-RCTs. The majority of early oral intake was provided within 6-8 hours after cesarean delivery. Early oral intake was significantly related to the return of gastrointestinal functions compared with delayed oral intake (bowel sounds -9.2 hours; passage of flatus -10 hours; bowel evacuation -14.6 hours). Early oral intake did not significantly increase the occurrence of gastrointestinal complications compared with delayed oral intake after cesarean delivery (ileus symptoms 18.7% compared with 18%, odds ratio [OR] 0.98; vomiting 5% compared with 5.5%, OR 0.9; nausea 10.3% compared with 10.3%, OR 1.03; abdominal distention 9.3% compared with 11.6%, OR 0.82; diarrhea 3.4% compared with 5%, OR 0.62). Early oral intake after cesarean delivery improves the return of gastrointestinal function and does not increase the occurrence of gastrointestinal complications. A clinical implication based on the findings of the current evidence is proposed.