Gastric Emptying in pregnancy is influenced by hormonal and mechanical factors leading to variations in its rate depending on trimesters and specific conditions such as labor or Caesarean delivery. [1]
How is gastric emptying delayed in pregnancy?
Hormonal and Mechanical factors are responsible for delay in gastric emptying in pregnancy. Smooth muscle relaxation caused by progesterone leads to inhibitory effects in gastric emptying in early pregnancy and lasting through the pregnancy period. The mechanical factor is the obstruction caused by the gravid uterus in the late stage of pregnancy.[2]
Impact of delayed gastric emptying on Pregnancy
Delayed gastric emptying possesses a significant impact on maternal and fetal outcomes particularly when associated with conditions like gastroparesis.
Delayed gastric emptying is consistently linked to gastroparesis, and has a higher risk of preeclampsia compared to pregnancies without gastroparesis.
Women with delayed gastric emptying are at increased risk of malnutrition and anemia, which can further worsen pregnancy complications.
Intense nausea and vomiting strongly correlated with delayed gastric emptying can lead to dehydration and electrolyte imbalance.
Delayed gastric emptying increases the risk of pulmonary aspiration during anesthesia for cesarean delivery and other surgical interventions.
Delayed gastric emptying may result in poor maternal nutrition increasing the risk of intrauterine growth restriction and low birth weight. [3]
Nutritional support, glycemic control, and tailored medical care are crucial in mitigating these adverse outcomes.
Guidelines to reduce the risk of pulmonary aspiration.
It is advised to advocate a fasting period of 2 h for clear liquids and 6 to 8 h for solids before Caesaren delivery or other surgical interventions.American Society of Anesthesiologists (ASA) and the Society for Obstetric Anesthesia and Perinatology (SOAP) in the USA a
The ‘Sip-Til-Send’ initiative has enabled them to drink sips of water only until they are called for surgery. It has decreased the incidence of nausea and vomiting, lightheadedness, and thirst, increased comfort, and reduced the rate of anxiety in women.
Recently a study was published in the British Medical Journal about the effects of pregnancy on gastric emptying.
This study was conducted to find the effects of pregnancy in gastric emptying during various pregnancy stages, during the time of cesarean delivery, during labor, and in the postpartum period. The study included women who were in any trimester of pregnancy, in labor, or having elective or emergency Caesarean delivery and nonpregnant women. The study assessed the indices of gastric emptying after liquids, solids, or both and then fasted in all the stages as explained above. There were about 32 observational studies, one randomized controlled study, and 22 randomized controlled trials were done. The study also sought to review the influence of anesthetic-related medications such as epidural local anesthetic with or without opioids on gastric emptying.[2],[3]
Findings of the study
Gastric emptying is decreased in the first trimester of pregnancy, not in the second and third.
Carbohydrate drinks or tea with milk do not impact gastric emptying before Caesarean delivery.
Gastric emptying is decreased in labor and with systemic opioids whereas gastric emptying is increased with epidural analgesia but not back to baseline.
Inconsistencies in literature reflect the unpredictability of gastric emptying in pregnancy.
Conclusion
Gastric emptying is not uniformly delayed across all stages of pregnancy, specific conditions such as early pregnancy, labor, or gastroparesis can significantly impact its rate. These changes have important clinical implications for maternal care and anesthesia management.
References
Lawson, Jacob, Ryan Howle, Petar Popivanov, Maria Leong, Desire Onwochei, and Neel Desai. "Gastric Emptying in Pregnancy and Its Clinical Implications: A Narrative Review." PubMed, Accessed February 12, 2025. https://pubmed.ncbi.nlm.nih.gov/39443186/.
Moosavi, Sarvee, Yang Won Min, Melissa Wong, and Ali Rezaie. "Gastroparesis in Pregnancy." American Journal of Obstetrics and Gynecology 228, no. 4 (April 2023): 396–405. https://www.binasss.sa.cr/abr23/5.pdf.
Achong, Naomi, N. Fagermo, K. Scott, and M. D'emden. "Gastroparesis in Pregnancy: Case Report and Literature Review." Obstetric Medicine 4, no. 1 (March 2011): 30–34. https://doi.org/10.1258/om.2010.100044.
(Input from various sources)
(Rehash/Dr. Ansila S/MSM)