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Ding T, Deng CM, Shen XF, Bai YW, Zhang XL, Liu JP, Yang LJ, Yu HT, Xie L, Chen H, Mu DL, Qu Y, Yang HX, Bao AR, Zhu SN, Wang DX. Effect of a carbohydrate-rich beverage on rate of cesarean delivery in primigravidae with epidural labor analgesia: a multicenter randomized trial. BMC Pregnancy Childbirth 2022; 22:339. [PMID: 35440017 PMCID: PMC9019984 DOI: 10.1186/s12884-022-04659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Labor represents a period of significant physical activity. Inefficient energy supply may delay labor process and even lead to cesarean delivery. Herein we investigated whether ingestion of a carbohydrate-rich beverage could reduce cesarean delivery in laboring women with epidural analgesia. METHODS This multicenter randomized trial was conducted in obstetrician-led maternity units of nine tertiary hospitals in China. Primigravidae with single term cephalic pregnancy who were preparing for vaginal birth under epidural analgesia were randomized to intake a carbohydrate-rich beverage or commercially available low-carbohydrate beverages during labor. The primary outcome was the rate of cesarean delivery. Secondary outcomes included maternal feeling of hunger, assessed with an 11-point scale where 0 indicated no hunger and 10 the most severe hunger, and maternal and neonatal blood glucose after childbirth. RESULTS Between 17 January 2018 and 20 July 2018, 2008 women were enrolled and randomized, 1953 were included in the intention-to-treat analysis. The rate of cesarean delivery did not differ between the two groups (11.3% [111/982] with carbohydrate-rich beverage vs. 10.9% [106/971] with low-carbohydrate beverages; relative risk 1.04, 95% CI 0.81 to 1.33; p = 0.79). Women in the carbohydrate-rich beverage group had lower subjective hunger score (median 3 [interquartile range 2 to 5] vs. 4 [2 to 6]; median difference - 1; 95% CI - 1 to 0; p < 0.01); their neonates had less hypoglycemia (1.0% [10/968] vs. 2.3% [22/956]; relative risk 0.45; 95% CI 0.21 to 0.94; p = 0.03) when compared with those in the low-carbohydrate beverage group. They also had higher rates of maternal hyperglycemia (6.9% [67/965] vs. 1.9% [18/953]; p < 0.01) and neonatal hyperglycemia (9.2% [89/968] vs. 5.8% [55/956]; p < 0.01), but none required special treatment. CONCLUSIONS For laboring primigravidae with epidural analgesia, ingestion of a carbohydrate-rich beverage compared with low-carbohydrate beverages did not reduce cesarean delivery, but relieved maternal hunger and reduced neonatal hypoglycemia at the expense of increased hyperglycemia of both mothers and neonates. Optimal rate of carbohydrate supplementation remains to be determined. TRIAL REGISTRATION www.chictr.org.cn ; identifier: ChiCTR-IOR-17011994 ; registered on 14 July 2017.
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Affiliation(s)
- Ting Ding
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China
| | - Chun-Mei Deng
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China
| | - Xiao-Feng Shen
- Department of Anesthesiology, Woman's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yao-Wu Bai
- Department of Anesthesiology, Tangshan Maternity and Child Health Care Hospital, Tangshan, Hebei, China
| | - Xiao-Lan Zhang
- Department of Anesthesiology, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Ji-Ping Liu
- Department of Anesthesiology, Foshan Maternal and Child Health Hospital, Foshan, Guangdong, China
| | - Li-Juan Yang
- Department of Anesthesiology, Urumqi Women and Child Health Care Hospital, Urumqi, Xinjiang, China
| | - Hai-Tao Yu
- Department of Anesthesiology, Linyi people's hospital, Linyi, Shandong, China
| | - Lei Xie
- Department of Anesthesiology, Anhui Women and Child Health Care Hospital, Hefei, Anhui, China
| | - Hong Chen
- Department of Anesthesiology, Women's Hospital of Zhejiang University, Zhejiang, Hangzhou, China
| | - Dong-Liang Mu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China
| | - Yuan Qu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China
| | - Hui-Xia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Ai-Rong Bao
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Sai-Nan Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku street, Beijing, 100034, China. .,Outcomes Research Consortium, Cleveland, OH, USA.
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Bouvet L, Garrigue J, Desgranges FP, Piana F, Lamblin G, Chassard D. Women's view on fasting during labor in a tertiary care obstetric unit. A prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 253:25-30. [PMID: 32768798 DOI: 10.1016/j.ejogrb.2020.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Maternal satisfaction and comfort may in part depend on fasting instruction given during labor. This study aimed to assess the satisfaction and the wishes of parturients with regards to fasting during labor. STUDY DESIGN This prospective cohort study was conducted among parturients assessing the fasting instructions they were given. We assessed whether women did have any oral intake during labor and focused on women's view of fasting during labor. Maternal discomfort related to thirst and hunger was assessed using 0-10 scales. RESULTS A total of 193 women were included, among whom 71 (37 %) received spontaneously given instructions and 60 (31 %) received instruction upon request. One hundred sixteen (60 %) women were allowed to drink clear fluids, in a limited way for 106 women (91 % of those concerned); 119 women did drink clear fluids during labor. One hundred thirty-two (68 %) women had a thirst-related discomfort score ≥ 4 without any statistical difference whether they had or had not drunk clear fluids. Colder water, unrestricted volume of water and sweet drink were desired by 74 (64 %), 38 (33 %) and 28 (24 %) women who had been allowed to drink, respectively. CONCLUSION These results emphasize that thirst contributes to maternal discomfort during labor. Permitting limited intake of water does not ensure high maternal satisfaction. Fresh clear fluids, unrestricted amounts of fluids and sweet fluids could contribute to improve maternal comfort.
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Affiliation(s)
- Lionel Bouvet
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France; University of Lyon, Claude Bernard Lyon 1 University, APCSe VetAgro Sup UPSP 2016.A101, 43 boulevard du 11 Novembre 1918, Marcy l'Etoile, 69100, Villeurbanne, France.
| | - Julie Garrigue
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France
| | - François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France; University of Lyon, Claude Bernard Lyon 1 University, APCSe VetAgro Sup UPSP 2016.A101, 43 boulevard du 11 Novembre 1918, Marcy l'Etoile, 69100, Villeurbanne, France
| | - Federica Piana
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France
| | - Géry Lamblin
- Department of Obstetrics and Gynecology Surgery, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, boulevard Pinel, 69500, Bron, France; University of Lyon, Claude Bernard Lyon 1 University, APCSe VetAgro Sup UPSP 2016.A101, 43 boulevard du 11 Novembre 1918, Marcy l'Etoile, 69100, Villeurbanne, France
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Bagherzadeh Karimi A, Elmi A, Mirghafourvand M, Baghervand Navid R. Effects of date fruit (Phoenix dactylifera L.) on labor and delivery outcomes: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:210. [PMID: 32290818 PMCID: PMC7157989 DOI: 10.1186/s12884-020-02915-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The rate of cesarean section is increasing in all over the world with different drafts in various countries. This growth increases unpleasant outcomes of delivery. Recent studies explained the benefits of date palm fruit on labor process improvement. Date fruit can be considered as a factor for increasing vaginal delivery and also reducing the frequency of caesarean section in order to prevent its great complications. This systematic review has been designed to review clinical studies that investigate the effects of date palm fruit on labor outcomes (duration of labor stages, bishop score, and frequency of cesarean section) compared with routine cares. METHODS This study was performed in 2019. Required data has been collected from electronic databases and manual searches. All randomized clinical trials evaluating the effects of date palm fruit on labor and delivery that were published from January 2000 to August 2019 in English and Persian languages, were incorporated in this systematic review. The methodological quality of the included studies was evaluated according to the risk of bias assessment of Cochrane handbook of systematic reviews, and were then reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS Eight studies were included in the qualitative and quantitative synthesis. Meta-Analysis showed that date fruit consumption can significantly reduce active phase of labor (three trials with 380 participants; (MD = - 109.3, 95%CI (- 196.32, - 22.29; I2 = 89%), P = 0.01), and also it can significantly improve the bishop score (two trials with 320 participants; MD = 2.45, 95%CI (1.87, 3.04; I2 = 0%), P < 0.00001). Date fruit consumption had no effects on the duration of first, second, and third stages of labor, and the frequency of cesarean section. CONCLUSION Date can reduce the duration of active phase and improve the bishop score; however, due to from the low to mediate quality of the studies; it seems that the other studies are needed to prove these results better than this.
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Affiliation(s)
- Alireza Bagherzadeh Karimi
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asghar Elmi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mojgan Mirghafourvand
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roghaiyeh Baghervand Navid
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Vallejo MC, Cobb BT, Steen TL, Singh S, Phelps AL. Maternal outcomes in women supplemented with a high-protein drink in labour. Aust N Z J Obstet Gynaecol 2013; 53:369-74. [DOI: 10.1111/ajo.12079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Manuel C. Vallejo
- Department of Anesthesiology; Magee-Womens Hospital of UPMC; Pittsburgh; Pennsylvania; USA
| | - Benjamin T. Cobb
- University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Talora L. Steen
- University of Pittsburgh School of Medicine; Pittsburgh; Pennsylvania; USA
| | - Sukhdip Singh
- Department of Anesthesiology; Magee-Womens Hospital of UPMC; Pittsburgh; Pennsylvania; USA
| | - Amy L. Phelps
- Duquesne University School of Business; Pittsburgh; Pennsylvania; USA
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King R, Glover P, Byrt K, Porter-Nocella L. Oral nutrition in labour: 'whose choice is it anyway?' A review of the literature. Midwifery 2010; 27:674-86. [PMID: 20850211 DOI: 10.1016/j.midw.2010.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 03/30/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE to identify factors affecting women's oral nutrition in labour. DESIGN literature review (1988-2009). SETTING Westernised maternity care settings. PARTICIPANTS women, midwives, obstetricians, anaesthetists and hospitals. MEASUREMENTS AND FINDINGS when addressing labour stages, the risk categorisation of women and maternal/fetal birthing outcomes, there was a lack of consistent evidence identifying adverse outcomes for mothers/infants when oral nutrition in labour had occurred. KEY CONCLUSIONS little evidence exists to support the continuance of restrictive practices around oral nutrition in labour for all women. Women's choice is impacted by health practitioners' opinions, experience and practice methods and policy (or lack thereof). Policies are not reflective of current evidence. IMPLICATIONS FOR PRACTICE women's choices and desires regarding oral nutrition in labour need to be addressed. Clear guidelines/policies need to be established based on current evidence. Midwives need greater exposure to research, as well as involvement in policy development and implementation.
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Affiliation(s)
- Ruth King
- Women's & Children's Hospital, 72 King William Road, North Adelaide, 5006, South Australia, Australia.
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Kardel KR, Henriksen T, Iversen PO. No effect of energy supply during childbirth on delivery outcomes in nulliparous women: a randomised, double-blind, placebo-controlled trial. J OBSTET GYNAECOL 2010; 30:248-52. [PMID: 20373924 DOI: 10.3109/01443610903531428] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The effect of providing oral energy supplements of energy on duration of labour and labour outcomes remains to be clarified. The purpose of this study was to examine whether extra energy supply beyond a self-regulated dietary intake during labour would shorten duration of labour in nulliparous women. A total of 213 healthy women at gestational age >36 weeks received either 1 litre of isotonic energy-drink (n = 111) or placebo-drink (n = 102) at the start of labour. A total of 61% in the intervention group gave birth within the hospital median of 9 hours, compared with 58% in the placebo group (p = 0.68). The mean (SD) durations of labour were 528 (240) minutes and 506 (233) minutes in the intervention and placebo group (p = 0.50), respectively. Extra oral supply of 1 litre energy drink beyond self-regulated intake of food and drink to healthy nulliparous women in birth does not affect the duration of labour.
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Affiliation(s)
- K R Kardel
- Department of Obstetrics and Gynaecology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Sweidan M, Mahfoud Z, DeJong J. Hospital Policies and Practices Concerning Normal Childbirth in Jordan. Stud Fam Plann 2008; 39:59-68. [DOI: 10.1111/j.1728-4465.2008.00151.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jamal A, Choobak N, Tabassomi F. Intrapartum maternal glucose infusion and fetal acid-base status. Int J Gynaecol Obstet 2007; 97:187-9. [PMID: 17368645 DOI: 10.1016/j.ijgo.2007.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Revised: 01/20/2007] [Accepted: 01/31/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the effects of an intrapartum infusion of a lactated Ringer solution or a glucose-boosted saline solution on the acid-base status of umbilical arterial blood. METHOD In a prospective clinical trial 178 women in labor were randomized to receive intravenously either a lactated Ringer solution or a saline solution boosted with 5% glucose. Umbilical arterial blood was then assessed for acid-base status. RESULTS There were significant differences between the lactated Ringer group and the glucose group in umbilical artery pH values (7.25+/-0.07 vs. 7.28+/-0.06; P=0.008), pCO2 values (44.8+/-5.6 mm Hg vs. 41.6+/-4.1 mm Hg; P=0.001), and base excess (-7.3+/-2.1 mEq/L vs. -6.6+/-1.8 mEq/L; P=0.02). CONCLUSION Intrapartum intravenous fluid containing a 5% glucose solution reduces umbilical cord acidemia and hypercarbia.
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Affiliation(s)
- A Jamal
- Perinatology Division, Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Tranmer JE, Hodnett ED, Hannah ME, Stevens BJ. The effect of unrestricted oral carbohydrate intake on labor progress. J Obstet Gynecol Neonatal Nurs 2005; 34:319-28. [PMID: 15890830 DOI: 10.1177/0884217505276155] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine if unrestricted oral carbohydrate intake during labor reduced the incidence of dystocia in low-risk nulliparous women. DESIGN AND SETTING A randomized clinical trial at a university-affiliated hospital in southeastern Ontario. Low-risk nulliparous women were randomized between 30 and 40 weeks gestation to either an intervention or usual care group. INTERVENTION Women in the intervention group received, prenatally, guidelines about food and fluid intake during labor and were encouraged to eat and drink as they pleased during labor. Women in the usual care group received no prelabor information and were restricted to ice chips and water during labor in the hospital. MAIN OUTCOME MEASURE The incidence of dystocia, defined as a cervical dilatation rate of less than 0.5 cm/hr for a period of 4 hrs after a cervical dilatation of 3 cm. RESULTS Three hundred twenty-eight women were randomized to the intervention (n = 163) or usual care (n = 165) groups. Women in the intervention group reported a significantly different pattern of oral intake during early labor in the hospital (chi(2) = 40.7, p < .001). The incidence of dystocia was 36% (n = 58) in the intervention group and 44% (n = 72) in the usual care group and was not significantly different (OR = 0.71, 95% CI = 0.46, 1.11). There were no significant differences in the other secondary outcomes or in the incidence of adverse maternal or neonatal complications. CONCLUSION Eating and drinking early in labor had no significant impact on the incidence of dystocia and/or adverse maternal or neonatal outcomes.
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Affiliation(s)
- Joan E Tranmer
- Nursing Research Unit, Kingston General Hospital, Kingston, Ontario, Canada K7L 2V7.
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Scheepers HCJ, de Jong PA, Essed GGM, Kanhai HHH. Carbohydrate solution intake during labour just before the start of the second stage: a double-blind study on metabolic effects and clinical outcome. BJOG 2005; 111:1382-7. [PMID: 15663123 DOI: 10.1111/j.1471-0528.2004.00277.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effects of oral carbohydrate ingestion on clinical outcome and on maternal and fetal metabolism. DESIGN Prospective, double-blind, randomised study. SETTING Leyenburg Hospital, The Hague, The Netherlands. POPULATION Two hundred and two nulliparous women. METHODS In labour, at 8 to 10 cm of cervical dilatation, the women were asked to drink a solution containing either 25 g carbohydrates or placebo. In a subgroup of 28 women, metabolic parameters were measured. MAIN OUTCOME MEASURES Number of instrumental deliveries, fetal and maternal glucose, free fatty acids, lactate, pH, Pco2, base excess/deficit and beta-hydroxybutyrate. RESULTS Drinking a carbohydrate-enriched solution just before starting the second stage of labour did not reduce instrumental delivery rate (RR 1.1, 95% CI 0.9-1.3). Caesarean section rate was lower in the carbohydrate group, but the difference did not reach statistical significance (1% vs 7%, RR 0.2, 95% CI 0.02-1.2). In the carbohydrate group, maternal free fatty acids decreased and the lactate increased. In the umbilical cord there was a positive venous-arterial lactate difference in the carbohydrate group and a negative one in the placebo group, but the differences in pH and base deficit were comparable. CONCLUSION Intake of carbohydrates just before the second stage does not reduce instrumental delivery rate. The venous-arterial difference in the umbilical cord suggested lactate transport to the fetal circulation but did not result in fetal acidaemia.
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Affiliation(s)
- H C J Scheepers
- Department of Obstetrics, Leiden University Medical Centre (LUMC), PO Box 9600, 2300 RC Leiden, The Netherlands
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O'Sullivan G, Scrutton M. NPO during labor. Is there any scientific validation? ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2003; 21:87-98. [PMID: 12698834 DOI: 10.1016/s0889-8537(02)00029-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Maternal death from pulmonary aspiration of gastric contents has virtually disappeared in the United Kingdom. The one case documented in the most recent triennial report was a woman with multiorgan failure in intensive care and is probably not relevant to the current debate [1]. Although not so well documented, other Western countries seem to be experiencing the same decline in maternal death from this cause. At the same time, the burden of proof is falling increasingly on obstetric anesthesiologists as obstetricians and midwives demand that NPO policies should be rejected, unless anesthesiologists can prove that they are necessary. Without any proof of benefit, many midwives actively encourage eating in women who do not really want to eat. A hospital manager who wants to divert money to other areas of health care might make the same argument about employing less experienced--and therefore cheaper--anesthesiologists or nurse anesthetists on the labor floor. Although no self-respecting obstetric anesthesiologist would accept such a situation, there is still no randomized controlled trial that proves that experienced anesthesiologists reduce maternal mortality. Similarly it is difficult for a mother to comprehend the negligible risk of pulmonary aspiration during labor while her care providers insist that it would be more dangerous for her to cross a busy road! Against a background of conflicting advice from midwives and medical practitioners, the mother is likely to eat if she feels so inclined. Pulmonary aspiration is a rare complication, so even if a light diet in labor became acceptable, it is likely that it would take many years for a subsequent increase in maternal mortality to become apparent. It would be disappointing if mistakes made by a previous generation had to be relearned in the twenty-first century. Increasingly, media-controlled pressure groups dictate health fashions, and the physicians frequently can only stand on the sidelines and advise. Most obstetric anesthesiologists agree that a rigid NPO policy in labor is no longer appropriate and that at least water or ice chips should be allowed. Current evidence suggests that solids and semi-solids should be avoided once a woman is in active labor or requests analgesia. The appropriate advice is to allow a carefully audited introduction of isotonic drinks. These drinks seem to be an effective medium for providing calories while minimizing any increase in gastric volume, and such a policy would be unlikely to reverse the reduction in aspiration that has been achieved over the past 50 years.
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Affiliation(s)
- Geraldine O'Sullivan
- Department of Anesthesia, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK. geraldine.o'
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