Rashad 2013.
| Methods | RCT conducted in King Khalid General Hospital, Kingdom of Saudi Arabia. | |
| Participants | 60 women. Most (80%) were multiparas, having an emergency CS (65%) under general anaesthesia (70%). No significant differences between groups for these characteristics. No information on previous CS. | |
| Interventions |
Intervention group (N = 30): "chew one stick of sugarless gum for 30 minutes, three times/day as soon as they are awake and return from the operating theatre to the ward." Time spent chewing = 90 min/d. "The researcher provided each woman with required amount of gum sticks". Control group (N = 30): "followed the postoperative hospital routine". No details on type of feeding protocol. |
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| Outcomes | Time to first flatus, time to defecation, time to first bowel sounds. Additional outcomes: time of feeling the first intestinal movement. |
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| Notes | No study protocol available. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Insufficient information: "They were then randomly assigned into two equal groups of 30; study and control". |
| Allocation concealment (selection bias) | Unclear risk | No information available. |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | The nature of intervention did not allow blinding of women and personnel. |
| Blinding of outcome assessment (detection bias) Subjective outcomes | High risk | Participants were unable to be adequately blinded in relation to passage of flatus or stools. |
| Blinding of outcome assessment (detection bias) Objective outcomes | Unclear risk | No information about blinding of outcome assessors for time to first bowel sounds. |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | All participants were analysed. No losses. |
| Selective reporting (reporting bias) | Low risk | All outcomes pre‐specified in Methods were reported in Results. No study protocol available. |
| Other bias | High risk | Duration of surgery (> 45 minutes) was significantly longer in intervention than in control group: 40% versus 13.3%, P = 0.02. |