Safety and efficacy of early postoperative solid food consumption after cesarean section.

Traditionally patients have received a physician-dictated regimen of gradual expansion of their diets following cesarean section. This has been based upon concern about the possibility of ileus from expanding the diet too rapidly. Given the economic necessity of earlier postoperative discharge following abdominal delivery, many patients have solid food reintroduced in their diets around the time they leave the hospital. This prospective, randomized, controlled study compared a traditional, gradual dietary expansion scheme with patient-determined reintroduction of solid food, which was offered within eight hours of surgery. The hypotheses were that women would eat more rapidly after cesarean section when given the opportunity and that early solid food consumption would reduce the need for analgesia. The results indicated that both hypotheses were correct. Given the opportunity, women will eat solid food very soon after cesarean section (mean +/- SD 10.2 +/- 5.2 hours from surgery to onset of solid food consumption) as compared to women on a traditional dietary expansion regimen (mean +/- SD 41.5 +/- 16.0 hours, P < .001). Women offered food within hours of cesarean section required less patient-requested injectable narcotic postoperatively than did women on gradual dietary expansion (median, 75 mg versus 225 mg meperidine, P < .05). There was no evidence of compromise of safety or comfort from introducing solid food early and allowing the patient to decide when to eat postoperatively. The conclusion from these data is that early postoperative feeding after cesarean section is a safe and effective alternative for most women, who now face early hospital discharge.

Warming fluid for amnioinfusion during labor.

While it has never been shown that warming fluid to body temperature prior to using it for amnioinfusion in labor is necessary, the practice is generally accepted. Ideally it is done with a blood warmer. Since blood warmers are expensive and not always available, fluid bags are often warmed in "constant temperature" devices used to heat blankets and fluid used in surgery. These units are ubiquitous, create no extra expense with their use and are a reasonable alternative to blood warmers. A study was designed to determine whether warming ovens actually did heat the fluids used for amnioinfusion to around 37 degrees C. Fluid bags were placed in the warming oven for 48 hours or more, and opening temperatures of the contained fluids were recorded. The temperatures were extremely variable, ranging from 21 degrees C to > 50 degrees C. The variability in opening temperatures was a result of wide temperature fluctuations in the warming oven itself and the condition of the fluid bags on removal. Blanket and surgical fluid warming ovens are not appropriate for heating fluids used in amnioinfusion during labor.