Pregnancy brings about notable changes in the gastrointestinal (GI) system, particularly affecting motility and gastric emptying. Hormonal shifts, especially the influence of progesterone, relax the lower esophageal sphincter (LES) and slow peristalsis. These effects promote gastroesophageal reflux, although gastric emptying itself remains essentially normal through pregnancy until labor begins. Combined with the increased pressure from the growing uterus, these changes heighten the risk of aspiration during anesthesia, particularly when general anesthesia (GA) or intubation is involved. The risk becomes even higher during labor, when pain, stress, and opioids slow gastric emptying, and in the postpartum period, especially when opioids are used.
To minimize aspiration risk, neuraxial techniques, such as epidurals, are generally preferred over general anesthesia. However, if GA is needed, rapid sequence induction with cricoid pressure is recommended to reduce aspiration risk. Additionally, aspiration prophylaxis using antacids or proton pump inhibitors can be employed. While fasting guidelines do not need significant changes for uncomplicated labor, moderate clear fluid intake should be allowed to maintain hydration while minimizing the risk of aspiration if GA becomes necessary. Paying close attention to gastric emptying and aspiration risk is essential for ensuring patient safety during anesthesia.
