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

Objective: Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a rare but serious complication following cesarean section (CS). Identifying factors associated with its occurrence is critical for early recognition and prevention. This systematic review and meta-analysis aimed to synthesize available evidence on factors associated with ACPO following CS. Methods: We performed a systematic literature search across five databases (PubMed, Embase, CNKI, Wanfang, and CBM) from inception to December 2025. Studies investigating factors associated with ACPO after CS were eligible. Quality of included studies was assessed using the Newcastle-Ottawa Scale. For factors reported in at least two studies, pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. Results: Five case-control studies comprising 484 patients (103 ACPO cases and 381 controls) were included, of which four were rated as good quality. Twenty-five potential associated factors were analyzed. Several pre-/intraoperative factors demonstrated statistically significant associations with ACPO risk, including concomitant anemia (OR = 8.94, 95% CI: 2.59-30.88), previous abdominal surgery (OR = 2.39, 95% CI: 1.28-4.47), surgery duration > 1 h (OR = 4.11, 95% CI: 2.20-7.67), and blood loss > 1000 mL (OR = 5.72, 95% CI: 2.10-15.58). Intraoperative blood loss as a continuous variable (WMD = 1.30, 95% CI: 0.14-2.46) was also significantly associated with ACPO. In contrast, emergency cesarean section, opioid use, and type of anesthesia were not significantly associated. Regarding postoperative features, bed rest > 12 h (OR = 2.66, 95% CI: 1.29-5.49), postoperative fever ≥ 38 °C (OR = 3.82, 95% CI: 1.94-7.54), elevated postoperative white blood cell count (WMD = 1.22, 95% CI: 0.30-2.14), and lower postoperative hemoglobin level (WMD = -0.50, 95% CI: -0.83 to -0.18) were significantly associated with ACPO. However, these factors may represent consequences of perioperative complications or components of the early clinical presentation of ACPO. Conclusions: This systematic review and meta-analysis identified multiple perioperative factors associated with ACPO following CS. However, the use of univariate data from a limited number of studies limits interpretability. Prospective cohort studies are needed to clarify whether these factors play a causal role in the development of ACPO.