Does chewing gum help my bowels move after caesarean?

We will discuss “Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta-analysis of randomised controlled trials” by Craciunas and co-workers from 25 June 2014. 

We will also relate to the following paper published in the same BJOG issue- “Effects of gum chewing on postoperative bowel motility after cesarean section: A meta-analysis of randomised controlled trials” by Ye and co-workers.

Both papers are free-to-view for four weeks from 16 June 2014. 

Start date: 25 June 2014 (the discussion will open for 7 days)

First hosted discussion session(s) starts at: 8pm UK time (GMT+1)

Host: @BlueJCHost

Platforms: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of each month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time.

All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (data S1).

The discussion points are attached below (quoted from the published manuscript)

ScenarioA patient who previously suffered from post-operative ileus after her first caesarean section has undergone an elective caesarean section of her second child. She asked immediate after the operation, “is there any way to help my bowel moving this time after my operation?”.

 Description of research

Participants Women who had caesarean section
Intervention Chewing gum with routine management
Comparison Routine management only
Outcomes Time to first flatus, time to first bowel movement, time to first stool and length of hospital stay
Study design Meta-analysis of randomised controlled trial

Discussion points

  • How common is ileus in your practice?
  • How would you currently manage the patient in the scenario?
  • Compare the methodology of these meta-analyses using the MOOSE and PRISMA checklists.
  • Which study has lower risk of bias and can you explain why you come to this conclusion?
  • Most existing trials analysed used surrogate outcomes (e.g. time to bowel movement) – are they good proxy for ileus?
  • What are the problems of overlapping meta-analyses? How can we solve them?
  • Can you briefly summarise the results of these studies? Have they changed your practice?

For those who want to understand hashtags, this may be a useful guide. For an introduction to #BlueJC, please refer to BJOG 2013;120:657–60. Follow @BlueJCHostthis blog and our Facebook page to receive news about #BlueJC.