[Preoperative fasting in labour].
Numerous scientific case reports and observational studies, including that of Curtis Mendelson with its great historical relevance, have reported the problem of aspiration pneumonitis during labour. Because of this, strict fasting prior to delivery to reduce pulmonary aspiration has been doctrine since the 1940s. However, maternal mortality from anaesthesia, particularly from aspiration, has dropped dramatically over recent decades. This is due both to far-reaching improved quality of care as well as technical progress in anaesthesia, which increasingly challenge the scientific basis for fasting in obstetric anaesthesia. Strict fasting has never been proven to reduce morbidity or mortality in labouring women. Because of the physiological and anatomical changes of pregnancy, gastric emptying is theoretically prolonged, and therefore the risk of aspiration is assumed to be increased. However, the available data with patients receiving clear fluids run contrary to this assumption, or at least dispute its clinical relevance. Recent studies report positive influence of reduced fasting time on both maternal comfort and maternal/fetal metabolism without increased risk. This has already led to meaningful discussion regarding a corresponding change in official recommendations.
Breuer
Jan-Philipp
JP
Klinik für Anästhesiologie und operative Intensivmedizin, Charité--Universitätsmedizin Berlin, Germany. philipp.breuer@charite.de
Correns
Ingrid
I
Spies
Claudia
C
D036861:Delivery, Obstetric; D005215:Fasting; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D011300:Preoperative Care