Risk factors for postoperative ileus after cesarean delivery


      Despite extensive data regarding risk factors for postoperative ileus in the general and colorectal surgery literature, few studies have identified risk factors specific to the obstetrical population.


      This study aimed to identify factors associated with postoperative ileus following cesarean delivery.


      This retrospective case–control study identified women who underwent cesarean delivery at a single hospital between January 2000 and January 2020 and subsequently developed postoperative ileus. Cases were matched in a 1:2 ratio with controls who underwent cesarean delivery and did not develop postoperative ileus. They were matched by age (±1 year) and body mass index (±1 kg/m2). Demographics, common comorbidities, obstetrical history, and delivery characteristics were analyzed.


      A total of 147 cases and 294 controls were identified. Cases and controls were similar in terms of parity, number of previous cesarean deliveries, labor preceding their cesarean delivery, incidence of chorioamnionitis, and presurgical diagnosis of hypothyroidism or chronic hypertension. Cases tended to have a diagnosis of preeclampsia (cases 23.1% vs controls 10.5%; P<.001) and were more likely to have been exposed to magnesium sulfate (cases 34.0% vs controls 15.0%; P<.001). Surgical considerations that were common in cases were exposure to general anesthesia (cases 37.4% vs controls 4.1%; P<.001), midline vertical skin incisions (cases 13.6% vs controls 1.4%; P<.001), classical hysterotomy (cases 8.8% vs controls 1.7%; P=.001), estimated blood loss >1000 mL (cases 44.4% vs controls 11.6%; P<.001), transfusion of blood products (cases 25.8% vs controls 2.0%; P<.001), and hysterectomy at the time of cesarean delivery (cases 6.1% vs controls 0.7%; P=.001). After a multivariable modeling using stepwise logistic regression of all variables found to be statistically significant, transfusion of blood products, estimated blood loss >1000 mL, and exposure to general anesthesia were the remaining surgical factors associated with the development of ileus. These variables reflect both the complexity and most likely the duration of surgery that was required, although we note that we did not have operative time as a variable to explore. Preeclampsia was also identified as a comorbidity linked to the development of ileus.


      A diagnosis of preeclampsia, exposure to general anesthesia, estimated blood loss >1 L, and transfusion of blood products were identified as potential risk factors for postcesarean ileus.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Venara A
        • Neunlist M
        • Slim K
        • et al.
        Postoperative ileus: pathophysiology, incidence, and prevention.
        J Visc Surg. 2016; 153: 439-446
        • Martin JA
        • Hamilton BE
        • Osterman MJK
        • Driscoll AK
        • Drake P
        Births: final data for 2017.
        Natl Vital Stat Rep. 2018; 67: 1-50
        • Blumenfeld YJ
        • El-Sayed YY
        • Lyell DJ
        • Nelson LM
        • Butwick AJ.
        Risk factors for prolonged postpartum length of stay following cesarean delivery.
        Am J Perinatol. 2015; 32: 825-832
        • Zlakishvili B
        • Sela HY
        • Tankel J
        • et al.
        Post-cesarean ileus: an assessment of incidence, risk factors and outcomes.
        Eur J Obstet Gynecol Reprod Biol. 2022; 269: 55-61
        • Vather R
        • Josephson R
        • Jaung R
        • Robertson J
        • Bissett I.
        Development of a risk stratification system for the occurrence of prolonged postoperative ileus after colorectal surgery: a prospective risk factor analysis.
        Surgery. 2015; 157: 764-773
        • Antosh DD
        • Grimes CL
        • Smith AL
        • et al.
        A case-control study of risk factors for ileus and bowel obstruction following benign gynecologic surgery.
        Int J Gynaecol Obstet. 2013; 122: 108-111
        • Goldstein JL
        • Matuszewski KA
        • Delayny CP
        • et al.
        Inpatient economic burden of postoperative ileus associated with abdominal surgery in the United States.
        P T. 2007; 32: 82-90
        • Moghadamyeghaneh Z
        • Hwang GS
        • Hanna MH
        • et al.
        Risk factors for prolonged ileus following colon surgery.
        Surg Endosc. 2016; 30: 603-609
        • ten Broek RPG
        • Issa Y
        • Van Santbrink EJP
        • et al.
        Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis.
        BMJ. 2013; 347: f5588
        • Adanikin AI
        • Orji EO
        • Fasubaa OB
        • Onwudiegwu U
        • Ijarotimi OA
        • Olaniyan O.
        The effect of post-cesarean rectal misoprostol on intestinal motility.
        Int J Gynaecol Obstet. 2012; 119: 159-162
        • Golzarian J
        • Scott Jr, HW
        • Richards WO.
        Hypermagnesemia-induced paralytic ileus.
        Dig Dis Sci. 1994; 39: 1138-1142
        • Izdes S
        • Kesimci E
        • Kanbak O.
        Paralytic ileus as a complication of iatrogenic hypermagnesaemia without renal dysfunction.
        Anaesth Intensive Care. 2008; 36: 124
        • Sung SI
        • Ahn SY
        • Choi SJ
        • et al.
        Increased risk of meconium-related ileus in extremely premature infants exposed to antenatal magnesium sulfate.
        Neonatology. 2022; 119: 68-76
        • Kamyar M
        • Clark EA
        • Yoder BA
        • Varner MW
        • Manuck TA.
        Antenatal magnesium sulfate, necrotizing enterocolitis, and death among neonates < 28 weeks gestation.
        AJP Rep. 2016; 6: e148-e154
        • Koch KE
        • Hahn A
        • Hart A
        • et al.
        Male sex, ostomy, infection, and intravenous fluids are associated with increased risk of postoperative ileus in elective colorectal surgery.
        Surgery. 2021; 170: 1325-1330
        • Barbieux J
        • Hamy A
        • Talbot MF
        • et al.
        Does enhanced recovery reduce postoperative ileus after colorectal surgery?.
        J Visc Surg. 2017; 154: 79-85
        • Ashcroft J
        • Singh AA
        • Ramachandran B
        • et al.
        Reducing ileus after colorectal surgery: a network meta-analysis of therapeutic interventions.
        Clin Nutr. 2021; 40: 4772-4782
        • Grass F
        • Slieker J
        • Jurt J
        • et al.
        Postoperative ileus in an enhanced recovery pathway-a retrospective cohort study.
        Int J Colorectal Dis. 2017; 32: 675-681
        • Boitano TKL
        • Smith HJ
        • Rushton T
        • et al.
        Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy.
        Gynecol Oncol. 2018; 151: 282-286