Rectal misoprostol after cesarean delivery: does it affect recovery of bowel functions? A prospective randomized trial

Abstract

Rectal misoprostol after cesarean delivery: does it affect recovery of bowel functions? A prospective randomized trial N.K. Aref1,∗ 1Associate professor of Obstetrics and Gynecology, Faculty of Medicine, Taif University (Kingdom of Saudi Arabia) Summary Aim: To assess the efficacy of rectally administered misoprostol in the improvement of bowel function recovery after cesarean delivery (CD). Methods: This prospective randomized trial was conducted among 171 pregnant women subjected to term elective CD. Patients were divided equally into 3 groups by simple randomization. Participants in group A were given misoprostol 200 µg rectally; those in group B were given misoprostol 400 µg rectally just after CD but before leaving the operating theater, while the participants in group C did not receive any rectal drug. The study outcome measures were: duration before first bowel movement and start of the regular oral diet. Adverse effects, need for additional analgesics, and post-CD hospital stay period were also recorded. Results: The mean times to first audible intestinal sounds and to the first passage of flatus were significantly lower in group B (14.1 ± 1.4 h and 16.7 ± 2.3 h, respectively) when compared to both groups A and C [ 21.9 ± 5.3 h and 24.9 ± 5.7 h (A) vs. 23.6 ± 6.9 h and 27.1 ± 7.9 h (C)] (p = 0.001). It was found that notably, patients in group B resumed diet more quickly, with a mean period of 20.5 h, which was significantly faster than the remaining groups (29.8 h and 33.1 h in groups A and C, respectively Of great interest, patients in group B had a lower post-CD hospital stay (38.5 h vs. 59.2 h in group A and 64. 8 h in group C). Conclusion: For the recovery of bowel functions after CD, rectal administration of 400 µg misoprostol appears to be more effective than 200 µg of rectally administrated misoprostol or traditional feeding regimens. Key words: Misoprostol; Bowel motility; Cesarean section; Post-CS recovery.