IS NPO A NECCESSITY?

Fasting in labor is common practice among our attending physicians as we always see the word
NPO (short for nil per os) among patients going through labor. But is there really evidence to
suggest that if fasting is not done during labor, patients will aspirate gastric contents during
induction of anesthesia? The evidence does not support this common belief. In a systematic review done by Singata et al. at the University of Fort Hare/East London Complex, East London South Africa, and using the Cochrane Pregnancy and Childbirth Group Trials Register of 2009, the authors found that there was no benefit or harm done to these patients. Using randomized controlled trials (RCT) and quasi-RCTs, they identified 5 studies with a total population of 3130 women. All studies looked at women in active labor and at low risk of potentially requiring a general anaesthetic. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks. When comparing any restriction of fluids and food versus women given some nutrition in labor, the meta-analysis was dominated by one study undertaken in a highly medical oriented environment. There were no statistically significant differences identified in: cesarean section (average risk ratio (RR) 0.89, 95% confidence interval (CI) 0.63 to 1.25, five studies, 3103 women), operative vaginal births (average RR 0.98, 95% CI 0.88 to 1.10, five studies, 3103 women) and Apgar scores less than seven at five minutes (average RR 1.43, 95% CI 0.77 to 2.68, three studies, 2574 infants), nor in any of the other outcomes assessed. The study included only low risk women, consistent in the recommendation of the Philippine Obstetric Gynecology Society Clinical Practice Guideline 2009 which states that ordering NPO for women in labor is not justified. At present, there are no studies that looked specifically at women at increased risk complications.