背景:剖宫产(ERAC)后强化恢复途径的采用正在增加,但缺乏支持对ERAC具有特定益处的个体干预措施的证据。ERAC的一个关键因素是早期口服摄入。在非计划剖宫产中,产妇并发症更为常见。在计划的剖腹产中,立即全食可促进康复,但在分娩期间对计划外剖宫产的影响尚不清楚.
目的:评估非计划剖宫产后立即与按需口服全食对呕吐和产妇满意度的影响。
方法:在一所大学医院进行了一项随机对照试验。第一位参与者于2021年10月20日注册,最后一位于2023年1月14日注册,随访于2023年1月16日完成。.在计划外剖宫产后,妇女在到达产后病房时被评估为完全资格。主要结果是在最初24小时内呕吐(非劣效性假设,5%的非劣效性边缘)和产妇对其喂养方案的满意度(优势假设)。次要结果包括第一次进食的时间,食品和饮料在第一次饲料中消耗的数量,恶心,第一次进食后30分钟呕吐和腹胀,然后在手术后8、16和24小时,出院时,肠胃外止吐和阿片类镇痛使用,第一次母乳喂养和令人满意的母乳喂养,肠鸣音,胀气,第二餐,停止静脉输液,拔除导尿管,排尿,步行,住院期间呕吐和严重的产妇并发症。数据分析采用t检验,Mann-WhitneyU测试,卡方检验,适当时进行Fisher精确检验和重复测量方差分析。
结果:501名参与者被随机分组,立即或按需口服全食(三明治和饮料)。5/248(2.0%)与3/249(1.2%)报告的前24小时内呕吐,RR1.795%CI0.4-6.9(0.48%-8.28%)p=0.50,产妇满意度0-10评分分别为立即喂养和按需喂养的中位数[四分位数范围]8[6-9]和8[6-9]p=0.97。从剖宫产到第一餐的时间为1.9[1.4-2.7]vs4.3[2.8-5.6]p<0.001,第一肠音2.7[1.5-7.5]vs3.5[1.8-8.7]p=0.02,第二餐7.8[6.0-9.6]vs9.7[7.2-13.0]小时p<0.001,这些间隔在立即进食时更短。参与者更有可能同意向朋友推荐立即喂食228(91.9%)vs210(84.3%)RR1.0995%CI1.02-1.16p=0.009。然而,在最初的食物饲料,即时组和按需组的“完全没有吃”率为26/250(10.4%)vs8/247(3.2%),“全部吃”率为93/249(37.5%)vs106/250(42.8%)p=0.02。其他次要结果没有不同。
结论:与非计划剖宫产后立即口服全食相比,在分娩中不增加产妇满意度评分,也不低于术后呕吐。可以首选强调患者自主性的按需喂养,但应鼓励和提供最早的全面喂养。
The adoption of Enhanced Recovery After Cesarean is increasing, but evidence supporting individual interventions having a specific benefit to Enhanced Recovery After Cesarean is lacking. A key element in Enhanced Recovery After Cesarean is early oral intake. Maternal complications are more frequent in unplanned cesarean delivery. In planned cesarean delivery, immediate full feeding enhances recovery, but the effect of unplanned cesarean delivery during labor is not known.
This study aimed to evaluate immediate oral full feeding vs on-demand oral full feeding after unplanned cesarean delivery in labor on vomiting and maternal satisfaction.
A randomized controlled trial was conducted in a university hospital. The first participant was enrolled on October 20, 2021, the last participant was enrolled on January 14, 2023, and follow-up was completed on January 16, 2023. Women were assessed for full eligibility on arrival at the postnatal ward after their unplanned cesarean delivery. The primary outcomes were vomiting in the first 24 hours (noninferiority hypothesis and 5% noninferiority margin) and maternal satisfaction with their feeding regimen (superiority hypothesis). The secondary outcomes were time to first feed; food and beverage quantum consumed at first feed; nausea, vomiting, and bloating at 30 minutes after first feed, at 8, 16, and 24 hours after the operation, and at hospital discharge; parenteral antiemetic and opiate analgesia use; first breastfeeding and satisfactory breastfeeding, bowel sound, and flatus; second meal; cessation of intravenous fluid; removal of a urinary catheter; urination; ambulation; vomiting during the rest of hospital stay; and serious maternal complications. Data were analyzed using the t test, Mann-Whitney U test, chi-square test, Fisher exact test, and repeated measures analysis of variance as appropriate.
Overall, 501 participants were randomized into immediate or on-demand oral full feeding (sandwich and beverage). Vomiting in the first 24 hours were reported by 5 of 248 participants (2.0%) in the immediate feeding group and 3 of 249 participants (1.2%) in the on-demand feeding group (relative risk, 1.7; 95% confidence interval, 0.4-6.9 [0.48%-8.28%]; P=.50), and the maternal satisfaction scores from 0 to 10 were 8 (6-9) for the immediate feeding group and 8 (6-9) for the on-demand feeding groups (P=.97). The times from cesarean delivery to the first meal were 1.9 hours (1.4-2.7) vs 4.3 hours (2.8-5.6) (P<.001), first bowel sound 2.7 hours (1.5-7.5) vs 3.5 hours (1.8-8.7) (P=.02), and second meal 7.8 hours (6.0-9.6) vs 9.7 hours (7.2-13.0) (P<.001). These intervals were shorter with immediate feeding. The participants were more likely to agree to recommend immediate feeding to a friend (228 [91.9%] in the immediate feeding group vs 210 [84.3%] in the on-demand feeding group; relative risk, 1.09; 95% confidence interval, 1.02-1.16; P=.009). However, at first feed for food, ate \"nothing at all\" rates were 10.4% (26/250) in the immediate group and 3.2% (8/247) in the on-demand group, and \"eaten all\" rates were 37.5% (93/249) in the immediate group and 42.8% (106/250) in the on-demand group (P=.02). Other secondary outcomes were not different.
Compared with on-demand oral full feeding, immediate oral full feeding after unplanned cesarean delivery in labor did not increase the maternal satisfaction score and was not noninferior on postoperation vomiting. On-demand feeding with its emphasis on patient autonomy could be preferred, but the earliest full feeding should be encouraged and provided.