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A RANDOMISED CONTROLLED TRIAL OF EARLY INITIATION OF ORAL FEEDING AFTER CAESAREAN DELIVERY IN MULAGO HOSPITAL
Abstract
ABSTRACT
Background: The concept of early initiation of oral feeding after caesarean delivery is well
tolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperative
dietary management schedule could have major implications on the management of maternal
post-caesarean section mothers.
Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefits
and gastrointestinal functions in women who had undergone caesarean section in Mulago
Hospital.
Design: A randomised controlled study.
Setting: Mulago Hospital.
Subjects: One hundred and ninety two women admitted on the postnatal ward after
emergency or elective caesarean section for various indications and who satisfied the
eligibility criteria were recruited and randomized into the study. Assignment to the early
feeding group or routine feeding group was done randomly using a computer generated
numbers. The early feeding group were encouraged to take sips of water within six to eight
hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post
operative under supervision. The routine group were managed by restricting oral intake for
twenty four hours and administration of orals sips of water 24 to 48 hours post operative. The
outcome measures were rate of ileus symptoms, post operative presence of bowel sounds,
maternal pyrexia and acceptability and benefits of early feeding.
Results: The mean age, parity and gravidity were similar in the two groups. The study shows
that women of the early feeding group had more rapid return of their bowel function with
significant more shorter mean post operative time intervals to bowels sounds (24.2 hours
versus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8
hours versus 75.8 hours). The women who fed early, made more rapid recovery and
expressed their interest in earlier hospital discharge. The findings significantly indicated that
women in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) than
their control group (15.1 hours versus 17.8 hours). This could probably have been because
of the adequate rehydration and improved early energy intake. In comparison those who
were fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0
bottles). The average hospital stay was similar and not statistically significant in both groups
(5.5 days versus 6.0 days).
Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well tolerated
and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus.
Background: The concept of early initiation of oral feeding after caesarean delivery is well
tolerated by patients, yet not routinely practiced in Mulago Hospital. An effective postoperative
dietary management schedule could have major implications on the management of maternal
post-caesarean section mothers.
Objectives: To compare the effect of time initiation of oral feeding on acceptability, benefits
and gastrointestinal functions in women who had undergone caesarean section in Mulago
Hospital.
Design: A randomised controlled study.
Setting: Mulago Hospital.
Subjects: One hundred and ninety two women admitted on the postnatal ward after
emergency or elective caesarean section for various indications and who satisfied the
eligibility criteria were recruited and randomized into the study. Assignment to the early
feeding group or routine feeding group was done randomly using a computer generated
numbers. The early feeding group were encouraged to take sips of water within six to eight
hours followed by oral soup or milk at least 150 millilitres at a time within 8 to 12 hours post
operative under supervision. The routine group were managed by restricting oral intake for
twenty four hours and administration of orals sips of water 24 to 48 hours post operative. The
outcome measures were rate of ileus symptoms, post operative presence of bowel sounds,
maternal pyrexia and acceptability and benefits of early feeding.
Results: The mean age, parity and gravidity were similar in the two groups. The study shows
that women of the early feeding group had more rapid return of their bowel function with
significant more shorter mean post operative time intervals to bowels sounds (24.2 hours
versus 34.2 hours), passage of flatus (51.6 hours versus 62.1 hours) and bowel movement (67.8
hours versus 75.8 hours). The women who fed early, made more rapid recovery and
expressed their interest in earlier hospital discharge. The findings significantly indicated that
women in the early feeding group got out of bed (patient mobilisation) earlier (p = 0.001) than
their control group (15.1 hours versus 17.8 hours). This could probably have been because
of the adequate rehydration and improved early energy intake. In comparison those who
were fed early required less number of bottles of intravenous fluids (5.0 bottles versus 7.0
bottles). The average hospital stay was similar and not statistically significant in both groups
(5.5 days versus 6.0 days).
Conclusion: Early initiation of oral feeding after caesarean delivery is safe and well tolerated
and can be implemented without an increase in gastrointestinal symptoms or paralytic ileus.
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