SummaryGastro-oesophageal refrux during a 40-minute reflux provocation test was assessed by lower oesophageal pH monitoring in 25 pregnant women at term, and again on about the second day after delivery. At term 17 women refluxed a total of 29 times; after delivery five women refruxed once each. There was a significant decrease in gastro-oesophageal reflux by the second day after delivery ( p < 0.05). Gastro-oesophageal reJux is, however, only one of the factors that predisposes to acid aspiration pneumonitis.
Key wordsComplications; aspiration pneumonitis, gastro-oesophageal reflux. Anaesthesia; obstetric.Pregnant women at term who need a general anaesthetic must be protected against the risks of regurgitation and possible aspiration pneumonitis. Gastro-oesophageal reflux increases these risks; symptoms of reflux occur in 80% of women at term,' and lower oesophageal pH monitoring has shown an increased incidence of reflux at term, even in asymptomatic ~o m e n .~,~ There is no clear advice about when these women can be treated as normal after delivery, but precautions against regurgitation and aspiration pneumonitis, continued unnecessarily, have their own risks. In this study we used lower oesophageal pH monitoring to compare gastro-oesophageal reflux at term with that on the second day after delivery. A preliminary report has been pre~ented.~
MethodEthical permission was obtained for the study. Informed consent was given by 28 of the 85 mothers who were asked, a rate of recruitment of about 35%. Twenty-five of the 28 women were studied both before and after delivery; 16 were primigravida and nine multigravida. All but three had symptoms of gastro-oesophageal reflux at term; none had had symptoms before pregnancy, and none had symptoms more than 12 hours after delivery. They were starved for 4 hours and did not smoke for 2 hours before the study. No medication was taken that affects gastro-intestinal function.
