Re: [ozmidwifery] Sports drinks
Thanks Lisa, Wouldnt it be great if we could seek our 'evidence' from physiological labour. Im not sure how well these epiduralised induced women compare in these respects. Anyone got time to do formal studies?? Not me at this stage : ) Di - Original Message - From: Lisa Gierke [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 4:58 PM Subject: [ozmidwifery] Sports drinks Ovid Technologies, Inc. Email Service -- Results: Anesthesia Analgesia (C) 2002 by International Anesthesia Research Society. Volume 94(2), February 2002, pp 404-408 An Evaluation of Isotonic Sport Drinks During Labor [TECHNOLOGY, COMPUTING, AND SIMULATION: OBSTETRIC ANESTHESIA] Kubli, Mark FRCA(UK)*,; Scrutton, Mark J. FRCA(UK)+,; Seed, Paul T. MSc, Cstat++,; O' Sullivan, Geraldine PhD, FRCA(UK)* *Department of Anaesthesia, St. Thomas' Hospital, London, United Kingdom; +Department of Anaesthesia, St. Michael's Hospital, Bristol, United +Kingdom; and ++Maternal Fetal Research Unit, Department of Obstetrics ++Gynaecology, Guy's Kings and St. Thomas' School of Medicine, King's College, London, United Kingdom Supported by a grant from the Obstetric Anaesthetists' Association, United Kingdom. September 14, 2001. Address correspondence and reprint requests to M. Kubli, FRCA, Department of Anaesthesia, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom. Address e-mail to [EMAIL PROTECTED] -- Outline Abstract Methods Results Discussion References Graphics Table 1 Table 2 Table 3 Table 4 Abstract We compared the metabolic effects of allowing women isotonic sport drinks rather than water to drink during labor. The effect of these drinks on gastric residual volume was also evaluated. Sixty women in early labor (cervical dilation P = 0.000) and nonesterified fatty acids (P = 0.000) had increased and plasma glucose (P = 0.007) had decreased significantly in the Water-Only group. Gastric antral cross-sectional area after delivery was similar in the two groups. The incidence of vomiting and the volume vomited during labor and within the hour of delivery were also similar. There was no difference between the groups in any maternal or neonatal outcome of labor. In conclusion, isotonic drinks reduce maternal ketosis in labor without increasing gastric volume. -- In recent years, maternal mortality from acid pulmonary aspiration (Mendelson's syndrome) (1) has dramatically declined. In the Report on the Confidential Enquiries into Maternal Deaths in England and Wales (1991-1996), only one mother died from aspiration (2). There are several factors that may be associated with this audited improvement. These include the increased use of regional anesthesia for cesarean delivery, improved training of anesthesiologists, and, possibly, the introduction of nonparticulate antacids and H2-receptor antagonists. The role of nothing by mouth during labor, as recommended in the first Report on the Confidential Enquiries into Maternal Deaths (1952-1954), is less clear (2). Women in labor exhibit a state of accelerated starvation, with rapid increases in the blood levels of [beta]-hydroxybutyrate, acetoacetic acid, and the nonesterified fatty acids (NEFAs) from which they are derived and with a concomitant decrease in blood glucose (3). It has been suggested, although never scientifically proven, that these changes may have detrimental effects on uterine activity and the progress of labor (4). A previous study demonstrated that allowing laboring women to eat a light diet prevented the increase of plasma ketones and NEFAs (5). However, not surprisingly, feeding resulted in a significant increase in residual gastric volume, which could predispose to pulmonary aspiration should a complication of neuroaxial anesthesia occur or should general anesthesia be required unexpectedly. Isotonic drinks are rapidly emptied from the stomach and absorbed by the gastrointestinal tract (6,7) and therefore may theoretically provide a safer alternative to solid food. The aim of this study was to evaluate whether isotonic drinks would prevent ketosis without increasing the risk of potential aspiration. Methods St. Thomas' Hospital Ethics Committee granted approval for this project. After informed written consent, 60 women presenting in early labor (cervical dilation (R) (still), with the choice of either orange or lemon flavor. Lucozade Sport (still) contains a mixed carbohydrate profile (dextrose, maltodextrin, and glucose) of 64 g/L, a sodium of 24 mmol/L, potassium of 2.6 mmol/L, and calcium of 1.2 mmol/L and has a tonicity of 300 mOsm/kg. Women in the Sport Drinks group were encouraged to consume up to 500 mL (one bottle) in the first hour and then a further 500 mL every 3 to 4 h. Additionally, they were allowed to take small quantities of water as desired. Women
RE: [ozmidwifery] Sports drinks
Searches show some stuff in Practising Midwife which I can't even get abstracts for .maybe someone else can. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of diane Sent: Friday, 6 October 2006 5:13 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Sports drinks Thanks Lisa, Wouldnt it be great if we could seek our 'evidence' from physiological labour. Im not sure how well these epiduralised induced women compare in these respects. Anyone got time to do formal studies?? Not me at this stage : ) Di - Original Message - From: Lisa Gierke [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 4:58 PM Subject: [ozmidwifery] Sports drinks Ovid Technologies, Inc. Email Service -- Results: Anesthesia Analgesia (C) 2002 by International Anesthesia Research Society. Volume 94(2), February 2002, pp 404-408 An Evaluation of Isotonic Sport Drinks During Labor [TECHNOLOGY, COMPUTING, AND SIMULATION: OBSTETRIC ANESTHESIA] Kubli, Mark FRCA(UK)*,; Scrutton, Mark J. FRCA(UK)+,; Seed, Paul T. MSc, Cstat++,; O' Sullivan, Geraldine PhD, FRCA(UK)* *Department of Anaesthesia, St. Thomas' Hospital, London, United Kingdom; +Department of Anaesthesia, St. Michael's Hospital, Bristol, United +Kingdom; and ++Maternal Fetal Research Unit, Department of Obstetrics ++Gynaecology, Guy's Kings and St. Thomas' School of Medicine, King's College, London, United Kingdom Supported by a grant from the Obstetric Anaesthetists' Association, United Kingdom. September 14, 2001. Address correspondence and reprint requests to M. Kubli, FRCA, Department of Anaesthesia, St. Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, United Kingdom. Address e-mail to [EMAIL PROTECTED] -- Outline Abstract Methods Results Discussion References Graphics Table 1 Table 2 Table 3 Table 4 Abstract We compared the metabolic effects of allowing women isotonic sport drinks rather than water to drink during labor. The effect of these drinks on gastric residual volume was also evaluated. Sixty women in early labor (cervical dilation P = 0.000) and nonesterified fatty acids (P = 0.000) had increased and plasma glucose (P = 0.007) had decreased significantly in the Water-Only group. Gastric antral cross-sectional area after delivery was similar in the two groups. The incidence of vomiting and the volume vomited during labor and within the hour of delivery were also similar. There was no difference between the groups in any maternal or neonatal outcome of labor. In conclusion, isotonic drinks reduce maternal ketosis in labor without increasing gastric volume. -- In recent years, maternal mortality from acid pulmonary aspiration (Mendelson's syndrome) (1) has dramatically declined. In the Report on the Confidential Enquiries into Maternal Deaths in England and Wales (1991-1996), only one mother died from aspiration (2). There are several factors that may be associated with this audited improvement. These include the increased use of regional anesthesia for cesarean delivery, improved training of anesthesiologists, and, possibly, the introduction of nonparticulate antacids and H2-receptor antagonists. The role of nothing by mouth during labor, as recommended in the first Report on the Confidential Enquiries into Maternal Deaths (1952-1954), is less clear (2). Women in labor exhibit a state of accelerated starvation, with rapid increases in the blood levels of [beta]-hydroxybutyrate, acetoacetic acid, and the nonesterified fatty acids (NEFAs) from which they are derived and with a concomitant decrease in blood glucose (3). It has been suggested, although never scientifically proven, that these changes may have detrimental effects on uterine activity and the progress of labor (4). A previous study demonstrated that allowing laboring women to eat a light diet prevented the increase of plasma ketones and NEFAs (5). However, not surprisingly, feeding resulted in a significant increase in residual gastric volume, which could predispose to pulmonary aspiration should a complication of neuroaxial anesthesia occur or should general anesthesia be required unexpectedly. Isotonic drinks are rapidly emptied from the stomach and absorbed by the gastrointestinal tract (6,7) and therefore may theoretically provide a safer alternative to solid food. The aim of this study was to evaluate whether isotonic drinks would prevent ketosis without increasing the risk of potential aspiration. Methods St. Thomas' Hospital Ethics Committee granted approval for this project. After informed written consent, 60 women presenting in early labor (cervical dilation (R) (still), with the choice of either orange or lemon flavor. Lucozade Sport (still) contains a mixed carbohydrate profile (dextrose, maltodextrin, and glucose) of 64 g/L, a sodium of 24
RE: [ozmidwifery] Sports drinks
I think that there is no doubt about the fact that extra fluids reduces ketonuria, the debate is : Is ketonuria harmful or beneficial or just neutral? It may be that what is pathological in illness may be a product of normal metabolism in labour. From what I have read, Ketoacidosis is the harmful state, not ketonuria and ketonuria is not necessarily a symptom of ketoacisosis. More confused? MM
Re: [ozmidwifery] Sports drinks
What you're saying is what a lot of research into low carbing says, Mary. J - Original Message - From: Mary Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, October 06, 2006 5:32 PM Subject: RE: [ozmidwifery] Sports drinks I think that there is no doubt about the fact that extra fluids reduces ketonuria, the debate is : Is ketonuria harmful or beneficial or just neutral? It may be that what is pathological in illness may be a product of normal metabolism in labour. From what I have read, Ketoacidosis is the harmful state, not ketonuria and ketonuria is not necessarily a symptom of ketoacisosis. More confused? MM
RE: [ozmidwifery] Sports drinks
I too find the whole ketone thing confusing. When people are on the Atkins diet (high protein, low carbohydrate) they test their urine for ketones which indicates they are breaking down fat. So despite being well hydrated they may have quite alot of ketones in their urine. So when a woman is in labour, is it more likely to be the hard work she is doing rather than dehydration? Cheers MichelleMary Murphy [EMAIL PROTECTED] wrote:I think that there is no doubt about the fact that extra fluids reduces ketonuria, the debate is : Is ketonuria harmful or beneficial or just neutral? It may be that what is pathological in illness may be a product of normal metabolism in labour. From what I have read, Ketoacidosis is the harmful state, not ketonuria and ketonuria is not necessarily a symptom of ketoacisosis. More confused? MM On Yahoo!7 PS Trixi: Check back weekly for Trixi's latest update
