Summary of findings for the main comparison. Chewing gum compared to control for enhancing early recovery of bowel function after caesarean section.
| Chewing gum compared to control for enhancing early recovery of bowel function after caesarean section | ||||||
| Patient or population: women in the immediate postpartum period (within the first 24 hours) after having had a caesarean section Settings: all studies except one were conducted hospitals in low‐ and middle‐income countries Intervention: chewing gum Comparison: control (usual care in the post‐partum period) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Chewing gum | |||||
| Time to first passage of flatus In hours | The mean time to first passage of flatus in the control group was 30.36 hours | The mean time to first passage of flatus in the intervention groups was 7.09 h shorter than in the control group (9.27 to 4.91 h shorter) | Not estimable | 2399 (13 studies) | ⊕⊝⊝⊝ very low1,2,3 | 11 of these studies were conducted in Asia and 2 in Africa. |
| Proportion of participants with ileus | 11 per 100 | 5 per 100 (3 to 7) | RR 0.39 (0.19 to 0.80) | 1139 (4 studies) | ⊕⊕⊝⊝ low,4,5 | 3 of these studies were conducted in Asia and 1 in Africa |
| Number of participants with adverse effects or intolerance to gum | See comments | 3 of 925 participants in the intervention group had intolerance to gum | Not estimable | 1888 (8 studies) | ⊕⊕⊝⊝ low1,4 | 7 studies were conducted in Asia and 1 in the US. No events in the control group since it was not exposed to the intervention |
|
Time to passage of faeces in hours |
The mean time to first passage of faeces in the control group was 50.62 h | The mean time to first passage of faeces in the intervention groups was 9.22 h shorter than in the control group (11.49 to 6.95 h shorter) | Not estimable | 2016 (11 studies) |
⊕⊝⊝⊝ very low1,2,3 | 9 studies were conducted in Asia and 2 in Africa |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 High risk of bias in studies; participants were not blinded to the intervention and self‐reported this outcome 2 High heterogeneity (I2 = 95%) 3 Possibility of publication bias (funnel plot asymmetry) 4 Low number of events (lower than 300)
5 Three of four studies with unclear risk of bias for assessors evaluating this outcome