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Pregnant women can eat, drink during labor

NEW YORK, Jan 24, (RTRS): There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.
“Women should be free to eat and drink in labor, or not, as they wish,” the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.
“In my experience,” she told Reuters Health in an email, “most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities.”
Milosavlievic has “not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor.”
Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.
But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.
And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a “Committee Opinion” advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.
“As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common,” Dr William H. Barth, Jr, chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.
But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says “women should be able to make their own decisions about whether they want to eat or drink during labor, or not.”
Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. 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.
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Colonoscopy: Follow-up colonoscopy is both overused and underused, two new studies indicate.
Too often, patients at high-risk for colorectal cancer don’t receive timely “surveillance” colonoscopy but there is also over-utilization among low-risk patients who are unlikely to develop colon cancer, researchers found.
“This misuse wastes health care resources and risks development of cancers in high-risk patients that might have been preventable,” Dr Robert Schoen, of the University of Pittsburgh School of Medicine, and senior investigator on both studies, said in a written statement.
“We want people to get screened” for colorectal cancer with colonoscopy, Schoen told Reuters Health. “The issue is in the repeated colonoscopies,” he said.
Colonoscopy involves inserting a thin, flexible scope into the colon to look for cancer or polyps, which are growths that can become cancerous. With colonoscopy, the entire length of the colon can be inspected and any growths discovered can be immediately removed. It is considered the most sensitive way to screen for colon cancer.
Schoen and colleagues analyzed data on 3,627 participants in a large National Cancer Institute-sponsored cancer screening trial and found “substantial overuse” of surveillance colonoscopy among people at low-risk for colorectal cancer and “significant underuse” among those at high-risk.
Specifically, among 1,029 patients with no precancerous colorectal growths at their initial exam, 58 percent underwent a follow-up exam an average of every 3.9 years, although the recommendation would be to do so every 5 to 10 years. The researchers were unable to identify medical reasons for the premature follow up exams.
The researchers also found that within 5 years of the initial colonoscopy exam, only 58.4 percent of patients with advanced precancerous growths had a follow-up colonoscopy, despite the recommendation that they do so every 3 years.
“This is a clear example of an intervention not being utilized in relation to the risk,” said Schoen, whose study appears in the latest issue of the journal Gastroenterology.
The other study, published in the journal GIE: Gastrointestinal Endoscopy, shows that colorectal cancer may still occur, despite regular colonoscopy. In this study, Schoen and associates examined the timing and effectiveness of follow-up colonoscopy in 1,297 patients with a history of precancerous colorectal growths who had follow-up colonoscopy as recommended and were followed for up to 10 years.
Despite following the recommended surveillance schedule, nine people were diagnosed with colorectal cancer during the follow-up period.
The test is “not perfect — it’s never going to be perfect,” Schoen told Reuters Health.
“This study,” he added in a statement, “emphasizes that patients with a history of advanced polyps are at particular risk and should be monitored closely with timely surveillance examinations.”
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Lupus: Drugs used to treat malaria may be useful for patients with lupus, a chronic debilitating “autoimmune” disease, according to according to a new report.
In fact, the authors of the study, in the journal Arthritis and Rheumatism, recommend that doctors give the drugs to all patients with lupus.
Lupus is a chronic disease in which the immune system confuses its own healthy tissues with foreign tissues and sometimes attacks both. The condition can manifest as a skin rash or arthritis and may lead to damage to the kidneys, heart, lungs and brain to varying degrees. The disorder disproportionately affects women.
Doctors first realized decades ago that antimalarial drugs such as hydroxychloroquine could be used to treat the joint pain often seen in lupus, according to the Lupus Foundation of America. Since then, research has suggested that antimalarial therapy can help prevent flare-ups of lupus and reduce overall damage from the disease, Dr Bernardo A. Pons-Estel, from Hospital Provincial de Rosario, Argentina, and co-researchers note.
Pons-Estel and his team studied nearly 1,500 patients with lupus from 9 countries. They followed them for an average of about four and a half years. The study was not “blinded” — in other words, subjects, and their doctors, knew what treatments they were getting.
About 12 percent of the patients who did not use the drugs died during the follow-up period, compared to about 4 percent of those who did.
The difference was even higher for patients who used the drugs for more than two years.
After the team accounted for various factors, using antimalarial drugs appeared to reduce the risk of death during the study by almost 40 percent.
“The data presented, taken in conjunction with the data from the published literature, suggest that antimalarials should be used in all lupus patients regardless of their disease manifestation or disease duration,” the authors conclude.

The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.
The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

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