Factors Associated with Acute Colonic Pseudo-Obstruction After Cesarean Section: A Systematic Review and...

Area of Science:

• Gastroenterology and Hepatology
• Obstetrics and Gynecology
• Surgical Complications

Background:

• Acute colonic pseudo-obstruction (ACPO), or Ogilvie syndrome, is a rare but severe complication post-cesarean section (CS).
• Early identification and prevention strategies are crucial for managing ACPO following CS.
• Existing evidence on ACPO risk factors after CS requires synthesis.

Purpose of the Study:

• To systematically review and meta-analyze factors associated with ACPO occurrence after cesarean section.
• To identify pre-operative, intra-operative, and post-operative risk factors for ACPO in CS patients.

Main Methods:

• Systematic literature search conducted across five databases (PubMed, Embase, CNKI, Wanfang, CBM) up to December 2025.
• Inclusion of five case-control studies (484 patients: 103 ACPO cases, 381 controls) with quality assessment using the Newcastle-Ottawa Scale.
• Calculation of pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs) for associated factors.

Main Results:

• Significant pre/intraoperative risk factors for ACPO include anemia (OR=8.94), prior abdominal surgery (OR=2.39), surgery duration >1h (OR=4.11), and blood loss >1000mL (OR=5.72).
• Intraoperative blood loss (WMD=1.30) was also significantly associated with ACPO.
• Postoperative factors linked to ACPO include bed rest >12h (OR=2.66), fever ≥38°C (OR=3.82), elevated WBC (WMD=1.22), and lower hemoglobin (WMD=-0.50).

Conclusions:

• Multiple perioperative factors are associated with ACPO following cesarean section.
• The current analysis, based on limited univariate data, necessitates caution in interpretation.
• Prospective cohort studies are recommended to establish a causal relationship between identified factors and ACPO development.