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Oral intake in labour: a UK survey in collaboration with the Royal College of Midwives
Abstract Number: F 24
Abstract Type: Other
Introduction: In recent years the incidence of pulmonary aspiration in obstetric anaesthesia has fallen, leading to more liberal oral intake practices in labour across the UK. In 2007 the National Institute of Clinical Excellence (NICE) issued guidance for oral intake in labour, with different recommendations for uncomplicated labour (low aspiration risk-LAR) - light diet ; versus those who developed risk factors making general anaesthesia (GA) more likely, or who received opioids (higher aspiration risk-HAR) - liquids only. We reviewed UK practice in 2010.
Methods: The survey was distributed to all UK obstetric units.
Results: 145/243 (60%) units responded. 105/145 (72%) had a policy for oral intake in labour. Of these units: 90/105 (86%) identified women as either LAR or HAR and managed them differently with respect to oral intake in labour; 15/105 (14%) units did not differentiate between aspiration risk and managed all women identically. Only 47/105 (45%) units reported that their oral intake policy was influenced by risk factors for aspiration unrelated to pregnancy (ie difficult airway, obesity, diabetes). Table 1 shows the oral intake policies employed in UK units. 7/145 (5%) units reported adverse events they felt related to oral intake/fasting: 3 aspiration cases; 4 ketoacidosis cases.
Discussion: Balancing evidence for oral intake in labour with the rare risk of aspiration underpins why NICE recommendations differ for LAR/HAR women. Though the majority of units had a policy for oral intake in labour, and identified LAR/HAR groups, many were either more restrictive or liberal than NICE recommended. Of note were units who kept all labouring women nil by mouth, and those who allowed all labouring women unrestricted diet. A number of UK units also did not consider important non pregnancy related risk factors for aspiration in their policies. Should guidance be reinforced again? Should we adopt a more US approach where only clear fluids are advised in labour with further restrictions case by case? Units reported aspiration does still occur, and with one case in the last confidential enquiry it is food for thought.
References: American College of Obstetricians and Gynecologists Committee on Obstetric Practice (2009). ACOG Committee Opinion No. 441: Oral Intake During Labor, Obstet Gynecol. 114(3):714. National Institute for Health and Clinical Excellence (2007). Intrapartum care of healthy women and their babies during childbirth. RCOG Press, Londo