Acute colonic pseudo-obstruction after cesarean section and gastrointestinal symptoms⋆. (September 2020)

• Record Type: Journal Article
• Authors: Christensen, Katrine; Ostersen, Line H.; Glavind, Karin; Krarup, Anne L.; Kjærgaard, Niels
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 252(2020)
• Page Start: 418
• Page End: 423
• Publication Date: 2020-09
• Subjects: ACPO Acute colonic pseudo-obstruction -- ASA American Society of Anaesthesiologists -- CS Cesarean section -- GI-symptoms Gastrointestinal symptoms -- GSRS Gastrointestinal Symptoms Rating Scale -- HADS Hospital Anxiety and Depression Scale -- IBS Irritable bowel syndrome -- IBS-SSS Irritable Bowel Syndrome – Severity Scoring System -- IQR Interquartile range -- PHQ15 Patient Health Questionnaire 15 -- SF-36 The MOS 36-item Short-Form Health Survey -- VSI Visceral Sensitivity Index; Acute colonic-pseudo obstruction -- Ogilvie syndrome -- Cesarean section -- Gastrointestinal symptoms -- Irritable bowel syndrome; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2020.06.011
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To investigate whether women who developed acute colonic pseudo-obstruction (ACPO) after cesarean section have a higher degree of gastro-intestinal symptoms than women who did not develop ACPO after cesarean section. ACPO is a colonic dilatation without mechanical obstruction, and with an unknown pathophysiology. In younger people it is mostly seen in women after cesarean section. The hypothesis of the present study is that long-term consequences of gastrointestinal symptoms evolve after ACPO, due to the impact on the colon. Study design: 40 women who developed ACPO after cesarean section (cases) and 80 women, who did not develop ACPO after cesarean section (controls), were asked to participate in the study. The controls were matched based on time of cesarean section (± 14 days), age (±5 years), singleton or twin, parity, cesarean section grade, and ASA-group. Baseline characteristics and information regarding the cesarean section were collected from medical records. An electronic collection of surveys was distributed to the participants, including the following: Irritable Bowel Syndrome - Severity Scoring System (IBS-SSS), Rome IV, Gastrointestinal Symptoms Rating Scale (GSRS), Visceral Sensitivity Index (VSI), Patient Health Questionnaire 15 (PHQ15), The MOS 36-item Short-Form Health Survey (SF-36), and Hospital Anxiety and Depression Scale (HADS). The score from IBS-SSS after cesarean section was used as the primary outcome. Results: 25 cases and 37 controls participated in the study. A difference in blood loss was found with a median of 600 mL in cases, compared to 400 mL in controls during cesarean section (p = 0.002). No difference was found between cases and controls in the IBS-SSS score after cesarean section. However, cases yielded a higher difference between IBS-SSS before and after cesarean section, indicating a higher degree of deterioration in gastrointestinal symptoms (p = 0.026). In addition, cases reported a higher degree of pain in everyday life (p = 0.039). No difference was found in the remaining surveys. Conclusion: Women undergoing cesarean section developed mild grade of irritable bowel syndrome. However, gastrointestinal symptoms did not seem to be more prevalent in women who developed ACPO, although women with ACPO had a higher degree of deterioration in gastrointestinal symptoms than controls.