An empty stomach is delayed during childbirth, but less so in women having epidural analgesia

Doctor anesthesiologists favor that laboring ladies have an empty abdomen due to the decrease danger for aspiration (inhaling) of meals in case basic anesthesia for cesarean part turns into mandatory. Concerning this problem, a research revealed On-line First in Anesthesiology, the official peer-reviewed journal of the American Society of Anesthesiologists (ASA), finds “abdomen emptying” is considerably slower throughout labor—however considerably quicker in ladies who obtain an epidural for ache management.

“These outcomes counsel anesthesiologists ought to stay cautious about allowing solid food throughout labor, particularly when epidural analgesia just isn’t used,” in keeping with the report by Lionel Bouvet, M.D., Ph.D., and colleagues of Hospices Civils de Lyon, Lyon, France. The findings add new proof for the continuing debate as as to whether it is secure for girls to eat stable meals throughout labor.

Researchers assessed abdomen (gastric) emptying charges in 4 teams of ladies: 10 non-pregnant women, 10 pregnant ladies at full time period (round 39 weeks) however not in labor, 10 ladies in labor who didn’t obtain an epidural, and 10 ladies in labor who obtained an epidural for labor ache. On an empty abdomen, every girl ate a lightweight meal of yogurt. They then had ultrasound scans to match the speed of abdomen emptying—how lengthy it took for meals to go away the ladies’s stomachs—among the many 4 teams.

As in earlier research, abdomen emptying was considerably delayed for girls in labor with out epidural. The speed of abdomen emptying from 15 to 90 minutes after consuming was 52% in non-pregnant ladies and 45% in pregnant ladies at full time period, in comparison with 31% for laboring ladies who obtained an epidural and seven% for girls in labor who didn’t obtain an epidural.

With epidural analgesia, abdomen emptying occurred a lot quicker throughout labor than throughout labor with out epidural analgesia. After 90 minutes, the abdomen was empty in 3 out of 10 laboring ladies who obtained an epidural, in comparison with 0 of 10 ladies in labor who had not obtained an epidural. By 2 hours, the abdomen was empty in 6 of the ladies who obtained an epidural, in comparison with simply 1 girl with out an epidural.

Though clinical practice varies, present tips of the ASA and Society for Obstetric Anesthesia and Perinatology (SOAP) state that “Strong meals must be prevented in laboring sufferers,” reflecting a priority over the danger of aspiration in case anesthesia and surgical procedure are wanted. This new research is likely one of the first to systematically examine the extent of gastric emptying delay throughout late being pregnant and childbirth and with versus with out epidural labor analgesia.

The outcomes verify a “statistically and clinically vital” longer time to an empty abdomen amongst ladies in labor. Nevertheless, abdomen emptying just isn’t additional delayed—and in reality appears to happen quicker—for these receiving epidural analgesia. Primarily based on their findings, Dr. Bouvet and coauthors counsel {that a} gentle stable meal “might in all probability be allowed” for girls in labor who’re receiving epidural analgesia and regarded low danger of cesarean section inside at the very least the following 2 hours.

“The report by Dr. Bouvet and colleagues allows us to rethink our current practice of fasting throughout childbirth,” feedback Yandong Jiang, M.D., Ph.D., one of many editors of Anesthesiology. “It’s fascinating that girls giving beginning with an epidural shouldn’t have the extra stress of starvation, however as an alternative be allowed to eat a lightweight meal.”

This contrasts with the ASA/SOAP advice that girls in labor ought to devour solely clear liquids to stop aspiration, reminds Mark Zakowski, M.D., FASA, chair of ASA’s Committee on Obstetric Anesthesia. “This research clearly reveals that abdomen emptying is kind of a bit slower for women in labor, and that in the event that they eat even a lightweight meal of about 4 ounces of yogurt, many will nonetheless have meals of their stomach just a few hours later,” Dr. Zakowski stated. “For the reason that want for emergency cesarean could come up at any time, the present ASA/SOAP guideline of clear liquids solely throughout labor appears justified.”

Supplied by
American Society of Anesthesiologists