Aspiration prophylaxis in labour – room for improvement?

Introduction Pregnant women are at increased risk of aspiration, which may have serious consequences. Although use of regional anaesthesia in obstetrics has increased, morbidity and mortality is still an issue. Currently, aspiration prophylaxis is recommended for high risk labouring women, according to local guidelines. This involves dietary restrictions and administration of ranitidine 150 mg orally every six hours. Methods A prospective data collection was carried out in the Royal Free hospital from 1st July 2011 to August 2011. Women assessed as high risk were identified through standard criteria: BMI>35, previous Caesarean section (LSCS), diabetes mellitus, suspicious CTG, previous anaesthetic problems, pre-eclampsia, and hiatus hernia. Elective Caesarean sections were excluded. Results Out of 200 women screened, 34 were identified as high risk. 8/34 (23%) had ranitidine, and 20/34 (58%) had dietary restriction, which suggest poor compliance with existing guidelines. Of the high risk women identified, 11/34 (32%) had Emergency LSCS, 5/34 (14%) instrumental delivery, 1/34 (2.9%) manual removal of placenta, and 17/34 (50%) normal vaginal delivery. General anaesthesia was used for two women who had LSCS, only one of whom had been prescribed acid prophylaxis. Conclusions While pulmonary aspiration in pregnant women undergoing general anaesthesia is rare, it is still a potentially life threatening condition. These data would suggest that this important cause of maternal death may be underestimated, and, especially in view of increasing obesity of our population, needs addressing. Education of maternity staff regarding aspiration prophylaxis and early anaesthetic involvement for high-risk groups is recommended.