分娩時 輕食可能不會影響產婦或是新生兒的預後


  March 30, 2009 — 根據一項線上發表於3月25日英國醫學期刊的研究結果,分娩時輕食不會影響產婦或是新生兒的預後,或是增加嘔吐。
  
  英國倫敦Guy與St. Thomas國家健康基金會信託、St. Thomas醫院的Geraldine O'Sullivan醫師與其同事表示,目前在分娩時讓產婦維持空腹的理由,是保護她們不發生吸入性傷害,在緊急接生時必須進行全身麻醉。然而,在分娩時餓太久從未被證實影響肺部吸入性傷害的發生率,且部分臨床醫師與助產士考慮不讓產婦吃東西,可能對母親或是她們的胎兒是不好的,甚至是分娩的過程。分娩時進食是否將會影響正常分娩的能力、分娩時程或是其他產科與新生兒預後,目前仍然未知。
  
  這項研究的目的在於評估分娩時禁食對於產科與新生兒預後的影響。在倫敦教學醫院的一家生產中心,總共有2,426位即將臨盆的女性被隨機分派接受輕食或是僅提供水分。輕食包括分娩時固定時間吃低脂、低渣飲食,這些食物包括麵包、餅乾、蔬菜、水果、優格、湯與果汁;收納條件包括未產婦、沒有妊娠糖尿病、獨生子、頭位生產、且子宮頸擴張小於6公分。
  
  主要試驗終點是自發性自陰道生產,次要試驗終點是分娩時間、需要助產、或是器械與開腹生產、噁心與新生兒預後等等。
  
  兩組之間自發性自陰道生產的比例是相當的(44%;相對風險為0.99;95%信賴區間[CI]為0.90-1.08),新生兒預後也是差不多的。兩組之間的生產時間並沒有臨床上顯著差異(幾何平均值,相較於喝水為597分鐘與612分鐘;幾何平均值比值為0.98;95% CI為0.93-1.03)、開腹比例(30%相較於30%;相對風險為0.99;95% CI為0.87-1.12)或是嘔吐發生率(35%相較於34%;相對風險為1.05;95% CI為0.9-1.2)都是一樣的結果。
  
  研究團隊寫到,分娩時食用輕食並不會影響這群受試者的產科或是新生兒預後,也不會增加嘔吐的發生率。在分娩時被允許進食的婦女,相較於那些只能喝水的婦女,其分娩時間長度與外科分娩率相當。
  
  這項研究的限制為沒有足夠的統計力量顯示有害的證據。
  
  研究作者的結論是,吸入性肺炎顯著地與插管及使用呼吸器有關。在現代的產科執業中,使用局部麻醉,而不是空腹療程,比較可能降低吸入性傷害的風險,因而可以免於插管。雖然國家健康與臨床卓越機構已經建議,根據專家共識意見,正常分娩的女性可能可以在分娩時進食或是飲水,我們的研究顯示,這並不會改善產科或是新生兒預後。
  
  產科麻醉學會與St. Thomas醫院特別管理人贊助這項研究。試驗作者其中一位由Tommy的寶寶慈善基金會贊助。研究作者們表示沒有相關資金上的往來。

Eating Lightly During Labor May Not Affect Obstetric or Neonatal Outcomes

By Laurie Barclay, MD
Medscape Medical News

March 30, 2009 — Eating a light diet during labor did not affect obstetric or neonatal outcomes or increase vomiting, according to the results of a prospective, randomized controlled trial reported online first in the March 25 issue of the British Medical Journal.

"The current rationale for women fasting during labour is to protect them from pulmonary aspiration should general anaesthesia be needed for an emergency operative delivery," write Geraldine O'Sullivan, MD, from St. Thomas' Hospital, Guy's and St. Thomas' National Health Service Foundation Trust in London, United Kingdom, and colleagues. "However, prolonged fasting in labour has never been proved to influence the incidence of pulmonary aspiration, and some clinicians and midwives consider that preventing food intake can be detrimental to the mother, her baby, and the progress of labour. Whether food intake in labour will influence the ability to deliver normally, the length of labour, or other obstetric and neonatal end points is not known."

The goal of this study was to evaluate the effect of feeding during labor on obstetric and neonatal outcomes. At a birth center in a London teaching hospital, 2426 participants at term were randomly assigned to receive a light diet or water during labor. The diet consisted of low-fat, low-residue foods eaten during regular intervals during labor. Foods included bread, biscuits, vegetables, fruit, yogurt, soup, and fruit juice. Inclusion criteria were nulliparity, lack of diabetes, singleton pregnancy, cephalic presentation, and cervical dilatation of less than 6 cm.

Spontaneous vaginal delivery rate was the main study endpoint, and secondary outcomes were duration of labor, need for augmentation of labor, rates of instrumental and cesarean delivery, incidence of vomiting, and neonatal outcomes.

Both groups had the same rate of spontaneous vaginal delivery (44%; relative risk, 0.99; 95% confidence interval [CI], 0.90 – 1.08) and similar neonatal outcomes. There were no clinically meaningful between-group differences in the duration of labor (geometric mean: eating, 597 minutes vs water, 612 minutes; ratio of geometric means, 0.98; 95% CI, 0.93 – 1.03), the cesarean delivery rate (30% vs 30%; relative risk, 0.99; 95% CI, 0.87 – 1.12), or the incidence of vomiting (35% vs 34%; relative risk, 1.05; 95% CI, 0.9 – 1.2).

"Consumption of a light diet during labour did not influence obstetric or neonatal outcomes in participants, nor did it increase the incidence of vomiting," the study authors write. "Women who are allowed to eat in labour have similar lengths of labour and operative delivery rates to those allowed water only."

Limitations of this study include insufficient power to show evidence of harm.

"Aspiration pneumonitis/pneumonia is significantly associated with intubation and ventilation," the study authors conclude. "In modern obstetric practice it is the use of regional anaesthesia, thereby avoiding intubation, rather [than] fasting regimens that is likely to have reduced mortality from aspiration. Although the National Institute for Health and Clinical Excellence has recommended, on the basis of consensus opinion, that women in normal labour may eat/drink in labour, our trial shows that this will not improve their obstetric and neonatal outcomes."

The Obstetric Anaesthetists' Association and the Special Trustees of the St Thomas' Hospital supported this study. One of the study authors is supported by Tommy's—The Baby Charity. The study authors have disclosed no relevant financial relationships.

BMJ. Published online March 25, 2009.

    
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