Understanding Gastric Emptying in Pregnancy: Enhancing Clinical Practices and Reducing Anesthesia Risks

Recently published article aimed to assess the effect of pregnancy on gastric emptying and its clinical implications, particularly during different trimesters of pregnancy, at the time of Caesarean delivery, during labor, and in the postpartum period. The review highlighted the importance of understanding gastric emptying in pregnant women to reduce the risk of pulmonary aspiration during anesthesia, especially in the context of Caesarean delivery. Various factors were discussed, including the impact of analgesia choice and food intake on gastric emptying in pregnant women.

Findings on Gastric Emptying During Pregnancy

The findings of the review indicated that gastric emptying is decreased in the first trimester of pregnancy but not in the second and third trimesters. It was noted that carbohydrate drinks or tea with milk before Caesarean delivery did not significantly impact gastric emptying. In labor, gastric emptying was delayed with systemic opioids but increased with epidural analgesia, though not back to baseline levels. The review also emphasized the inconsistencies in the literature, reflecting the unpredictable nature of gastric emptying during pregnancy.

Discussion on Risk Factors and Techniques for Assessment

Further discussions in the review revolved around the historical association between pulmonary aspiration and anesthesia, risk factors for aspiration during pregnancy, and the impact of different factors on gastric emptying in various phases of pregnancy. The review also touched upon the utility of gastric ultrasound as a method for assessing gastric emptying in pregnant women and how it could be beneficial in clinical practice.

Methods for Conducting the Review

The methods section outlined the inclusion criteria for the review, which focused on pregnant females and included studies that evaluated gastric emptying in different phases of pregnancy compared to non-pregnant women. The review conducted a comprehensive search across various databases and assessed the quality and bias of included studies using specific tools. Results from the review encompassed data from observational studies and randomized controlled trials, highlighting changes in gastric emptying across different phases of pregnancy and postpartum. The impact of medications such as glycopyrronium and metoclopramide on gastric emptying in different stages of pregnancy was also discussed. For instance, glycopyrrolate and metoclopramide demonstrated varying effects on gastric emptying in pregnant women at different trimesters and postpartum.

Summary of Findings and Implications

In summary, the review detailed the complexities of gastric emptying in pregnant women throughout different stages of pregnancy, at the time of Caesarean delivery, during labor, and in the postpartum period. The findings underscored the importance of understanding the variations in gastric emptying during pregnancy to improve clinical practices and reduce the risk of complications, particularly during anesthesia and surgical procedures. The potential role of gastric ultrasound in assessing gastric emptying in pregnant women was highlighted as a valuable tool for clinical decision-making.

Key Points

- The narrative review focused on assessing the effect of pregnancy on gastric emptying and its clinical implications, particularly during different trimesters of pregnancy, at the time of Caesarean delivery, during labor, and in the postpartum period.

- Findings indicated that gastric emptying is decreased in the first trimester of pregnancy but not in the second and third trimesters. Factors such as carbohydrate drinks or tea with milk before Caesarean delivery did not significantly impact gastric emptying. - Discussion included risk factors for aspiration during pregnancy, the impact of different factors on gastric emptying in various pregnancy phases, and the potential utility of gastric ultrasound for assessing gastric emptying in pregnant women.

- The review outlined the methods used, including inclusion criteria, a comprehensive search across various databases, and assessment of study quality and bias.

- Results encompassed data from observational studies and randomized controlled trials, highlighting changes in gastric emptying across different phases of pregnancy and postpartum, including the impact of medications like glycopyrronium and metoclopramide on gastric emptying in pregnant women.

- In summary, the review emphasized the importance of understanding gastric emptying variations during pregnancy to enhance clinical practices, reduce complications during anesthesia and surgery, and highlighted the potential role of gastric ultrasound in clinical decision-making.

Reference –

Jacob Lawson et al. (2024). Gastric Emptying In Pregnancy And Its Clinical Implications: A Narrative Review. *BJA: British Journal Of Anaesthesia*, 134, 124 - 167. https://doi.org/10.1016/j.bja.2024.09.005.