In uncomplicated cases, liquids or solid food may be ofered within hours of surgery and advanced as tolerated (Guo, 2015). Some degree of adynamic ileus follows virtually every abdominal operation, but in most cases of cesarean delivery, it is negligible. Postoperative ileus symptoms include abdominal distention, gas pains, and an inability to pass flatus or stool. With persistent nausea and vomiting or with prolonged bowel function delay, radiological imaging may aid exclusion of bowel obstruction. A plain abdominal radiograph is a frequent first choice. However, in the general population, this study is diagnostic in only 50 to 60 percent of small bowel obstruction cases (Maglinte, 1997). Thus, a radiograph may best serve as a triage tool in cases in which ileus is the suspected diagnosis. Notably, an enlarged postpartum uterus can compress the rectosigmoid and prevent it from illing with gas. Thus, indings suggesting a distal colonic obstruction may confuse true cases of transient ileus (Kammen, 2000). In comparison, CT with intravenous contrast provides greater accuracy for small bowel obstruction. Oral contrast is concurrently given when SBO is a consideration (Katz, 2013). Last, although uncommon, an unrecognized bowel injury may be responsible for otherwise unexplained fever and poor bowel function. Here, CT may be most diagnostic of potential etiologies.
As treatment of ileus, intravenous luids compensate for poor oral intake and losses from emesis. Electrolyte imbalances are corrected to improve smooth muscle activity and avoid bowel edema. Nasogastric decompression is necessary only with persistent vomiting or severe distention.
For prevention, intraoperative goals strive to minimize bowel manipulation, avoid excess intravenous luids or profound hypovolemia, and limit surgery length (Bragg, 2015). Postoperatively, gum chewing enhances early bowel function recovery by nearly 7 hours after cesarean delivery (Zhu, 2014). Among studies, chewing was initiated immediately or up to 12 hours later, lasted 15 to 60 minutes, and was repeated in at least three sessions daily (Pereira Gomes Morais, 2016).
As discussed earlier, women undergoing cesarean delivery have an increased risk of venous thromboembolism compared with those delivering vaginally. Early ambulation lowers the thromboembolism risk. Walking to the bathroom begins, initially with assistance. Brief walks are encouraged, and ambulation can be timed so that a recently administered analgesic will minimize discomfort.
lthough not evidence based, we remove the surgical dressing after 24 hours and inspect the incision daily. One small randomized trial showed no wound healing diferences if removed at 6 hours (Peleg, 2016). By the third postpartum day, showering is not harmful to the incision. Prior to this, a plastic cover can maintain dryness during showers. If used, staples often are removed on the fourth day. Once removed, dressing strips (Steri-Strips) can be placed as needed for 1 week to reinforce skin edge integrity. If there is concern for supericial wound separation, staples remain in place for 7 to 10 days.
For uncomplicated cesarean delivery, the average hospitalization length is three to four days (Buie, 2010). Data from studies suggest that earlier discharge is feasible for properly selected women and newborns (Bayoumi, 2016; Tan, 2012). Protocols ideally include earlier reevaluation for neonatal jaundice.