Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study

Abstract

Background The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying rate of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women. Methods Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The rate of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) – 1] × 100, and half-time to gastric emptying was also determined. For the Parturient–Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia. Results The median (interquartile range) rate of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The rate of gastric emptying at 90 min was statistically significant and lower in the Parturient–Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the rate of gastric emptying at 90 min was statistically significant and lower in the Parturient–No-Epidural group than in the Parturient–Epidural group. Conclusions Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Limiting Oral Intake during Labor: Do We Have It Right?

“…Another interesting finding observed in the study by Bouvet et al 1 was that 9 of the 10 parturients without labor epidural analgesia still had solid food in the stomach 2 h after ingestion, in contrast to only 3 of the 10 parturients with labor epidural analgesia. The finding of facilitating gastric emptying with labor epidural analgesia is important.…”

“…Should those parturients receiving labor epidural analgesia be assessed differently? It is probably too soon to propose liberal intake for all parturients before further large-scale studies become available to validate the findings of Bouvet et al ., 1 but these important findings and others 12 enable us to at least start reevaluating current recommendations with scientific evidence rather than just relying on “opinions of experts” and largely baseless fears.…”

“…It is also worth noting that this difference in gastric emptying in parturients with and without labor epidural analgesia might be underestimated as only parturients without systemic opioids were included in the no epidural group in the study by Bouvet et al 1 However, in actual practice, parturients without epidural analgesia often choose systemic opioids, which cause delay in gastric emptying. 5,6 Even more interesting, in another study, it was observed that women who were allowed to eat a low-residue diet throughout labor, in general, became increasingly disinterested in eating as labor progressed; women with labor epidural analgesia, however, were an exception.…”

“…Reported here, Bouvet et al 1 conducted a well-designed prospective observational study and determined the dynamic of gastric emptying after intake of a light meal (less than 5 ounces of yogurt) in healthy nonpregnant women, term pregnant women, and parturients undergoing vaginal delivery with or without labor epidural analgesia. 1 Confirming what we already know, they found that gastric emptying in parturients is significantly delayed compared to that of nonpregnant or term pregnant women not in labor. The authors observed the gastric antral cross-section–area change (%) fraction over the period 15 to 90 min after ingestion.…”

“…The finding of the beneficial effect of labor epidural analgesia on gastric emptying in parturients is very encouraging. However, there are two weaknesses in the study by Bouvet et al 1 As the authors point out, only women who had an empty stomach at screening were included in the study. It was not described how many subjects in each group were excluded due to a nonempty stomach at this time.…”