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Gastric Emptying in Parturients with Epidural Analgesia: Using Gastric Ultrasonography to Determine Aspiration Risk A Randomized Controlled Trial
Abstract Number: O2-2
Abstract Type: Original Research
Introduction: Eating meals during labor is encouraged in many areas internationally based on the belief that labor is a metabolically active process. The rise of epidural analgesia in these areas can affect the risk of aspiration, as epidural medications are believed to reduce gastric emptying. We evaluated the benefit of offering a sports drink to parturients at a hospital in Nanjing, China receiving labor epidural analgesia as compared with those eating solid foods using gastric sonography to measure emptying, and also examined obstetric and neonatal outcomes.
Methods: We conducted a double-blind, randomized, controlled trial involving nulliparous women with term cephalic singleton pregnancies who requested and subsequently received labor epidural analgesia. After performing a baseline ultrasound, patients were randomized into three groups: 250 ml water, 250 ml sports drink, and a standardized soup containing noodles and eggs. Gastric antral cross-sectional area was measured immediately after consumption and then patients were studied for 6 hours or until their stomachs were empty. Data on maternal and neonatal outcomes were collected.
Results: 88 patients completed the study: 23 in the soup group, 33 in the sports drink group, and 32 in the water group. Mean time to baseline gastric CSA in soup group was 4.4 hours compared with 1.9 hours in the sports drink group and 1.4 hours in the water group (p<0.001). Gastric emptying half-time was also longer in the soup group (105 vs. 57 vs 42 min, P<0.001). There was no difference in maternal or neonatal outcomes among groups, specifically in umbilical artery blood gas or blood glucose data. There was a higher rate of C/S in the water group of 21.88% as compared with 8.70% and 6.06% in the soup and sports drink groups respectively.
Conclusions: Gastric emptying time assessed by gastric sonography in parturients under epidural analgesia reveals that solid foods empty significantly more slowly than clear liquids which increases the risk of aspiration. Of note, the gastric emptying times in active labor under epidural analgesia are faster than reported in non-laboring patients. When parturients are restricted to clear liquids, there is no change in maternal or neonatal outcomes and no increased risk of neonatal acidosis or hypoglycemia. However, the significantly higher rate of C/S in the group receiving no nutritional support merits further investigation.