Impact of gum chewing on recovery of bowel activity after caesarean section

Background: Childbirth is a memorable part in every woman’s life. Each labour experience is unique and calls for a celebration. Objective of this study was to evaluate the effect of gum chewing on recovery of bowel motility after caesarean section.Methods: This prospective randomized controlled trial was conducted on 220 women who had undergone cesarean section and were further sub-divided into two groups of 110 women each Group I (Study group, n=110) in whom chewing gum was advised postoperatively and Group II (Control group, n=110)  who were managed as per standard departmental postoperative feeding protocol.Results: Mean age in Group A women was 24.86±3.89 years and 25.28±3.34 years in Group B. There was no statistically significant difference between the study and control group regarding their age, parity, occupation, LSCS/previous abdominal surgery, type of cesarean section, indications of cesarean section, skin incision, intraperitoneal adhesions. The mean time of bowel sound appearance in Group A was 3.27±0.95 and it was 8.22±2.0 hours in Group B. The mean time of passage of flatus was found to be 9.77±3.21 hours in Group A and 7.15±3.07 hours in Group B. In Group A, the mean time of passage of stools was 18.79±4.23 hours and it was 39.12±6.56 hours in Group B. Mean duration of hospital stay was significantly lesser (3.23±0.60 days) in gum chewing group than in the non-gum chewing group (4.18±1.28 days).  Seventy-six (69.09%) women of Group A needed only one chewing gum before appearance of bowel sound / flatus / feces. Only three women required three chewing gums. Out of 31 cases, who required two chewing gums, five were of previous 1 LSCS and 12 were previous 2 LSCS, thus suggesting delayed return of gut motility in women with > 1 previous LSCS.Conclusions: It was evident that gum chewing, a form of sham feeding is considered as an effective and inexpensive method which hastens the return of gut motility after caesarean section.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Meconium Staining of Amniotic Fluid- A Poor Indicator of Fetal Compromise.

The presence of meconium at the onset of labour and its obstetric outcome was studied over a 3 month period. Out of the 1267 deliveries that occurred during this period, 100 (7.89%) had meconium staining of liquor. These were compared to the remaining 1167 patients with clear liquor. Monitoring included cardiotocography, scalp pH estimation when required and optimal care at delivery.The fetal heart rate abnormalities were more common in meconium stained patients. Thick meconium staining was associated with higher cesarean section rate, low Apgar score at one minute and more admissions to the neonatal intensive care unit.All women with meconium staining of liquor should be cardiotocographically monitored in labour and managed by optimal timely intervention in order to avoid severe asphyxia and meconium aspiration.

Mullerian, Renal and Skeletal Anomalies A Rare Association.

The MURCS syndrome is a very rare complex association of mullerian, renal tract and cervicothoracic somite anomalies. A case of a 17 years old girl with these associations and a management pitfall is presented and the embryology and management options discussed.

Normal Obstetric Outcome in Neurofibromatosis-1 Complicating Pregnancy.

Neurofibromatosis (NF), a genetic disorder, has increased risk of obstetric complications as well as aggravation of maternal disease. However, here is a case of Neurofibromatosis associated with normal obstetric outcome despite the aggravation of dermatological lesions.