BACKGROUND Peri-operative fasting guidelines allow clear fluids including tea without milk to be consumed up to 2 h before surgery. Recent evidence has shown that a modest amount of milk consumed with clear fluids does not significantly slow gastric emptying. OBJECTIVES The aim of this study was to compare the gastric emptying of tea with milk versus water using ultrasonography in fasted pregnant patients. DESIGN A randomised controlled trial quantifying gastric emptying in two groups using ultrasonography by an operator blinded to the group allocation. SETTING Department of Anaesthesia and Peri-operative Medicine, Coombe Women and Infants University Hospital, Dublin. The study was conducted between October 2018 and June 2019. PARTICIPANTS Total 50 nonlabouring pregnant women, more than 36 weeks gestation. INTERVENTIONS After a standard overnight fast, women were randomised to either 250 ml of water or 250 ml of tea with milk. All patients underwent a gastric ultrasound assessment at regular intervals for 2 h after consumption of their drink. MAIN OUTCOME MEASURE The primary outcome was the difference in gastric antrum cross-sectional area (CSA) at 2 h. RESULTS A total of 50 women were recruited to the study. There was no significant difference in the median [IQR] gastric antrum CSA in either group at 2 h: 3.2 cm2 [2.3 to 3.7] vs. 3.1 cm2 [2.6 to 3.9]; P = 0.720. The gastric antrum CSA had returned to its baseline measurement in both groups by 90 min. CONCLUSION The change of gastric antrum CSA after 250 ml of tea with milk is similar to a corresponding volume of water in fasted pregnant patients. This study could help inform future peri-operative fasting guidelines regarding the use of a modest volume of milk with clear fluids. TRIAL REGISTRY NUMBER NCT 03694509 ClinicalTrials.gov.

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Operative Vaginal Birth (OVB) refers to the birth of a baby where the operator assists the delivery using either a forceps or vacuum device. The obstetrician in training needs to develop expertise in both vacuum and forceps for non-rotational delivery and at least one technique for rotational delivery. The aim of a successful operative vaginal birth is to expedite delivery of the baby with a minimum of maternal or neonatal morbidity. The alternatives to operative vaginal birth are expectant management or caesarean section. Expectant management may risk worsening of fetal compromise and caesarean section in the section stage of labour carries significant morbidity, and implications for future births. OVB guidelines such as those of the Royal College of Obstetricians and Gynaecologists (RCOG) provide clear recommendations for standard indications for assisted birth but less guidance on circumstances that deviate from routine care. This case-based article gives three illustrative scenarios that highlight the decision-making processes that are required when providing complex care and includes suspected fetal macrosomia, preterm birth, and management of the second twin.

(Eur J Anaesthesiol. 2020;37:303–308) Fasting guidelines from the American Society of Anesthesiologists (ASA) and European Society of Anaesthesiologists (ESA) recommend that clear fluids, including tea without milk, can be ingested up to 2 hours before general or regional anesthesia. Milk is considered to have the same gastric emptying time as solid food and requires a fasting period [nil per os (NPO) time] of 6 hours. While both guidelines suggest that a small amount of milk may be added to clear fluids without impacting NPO times, there is little evidence to support this guidance. The aim of this study was to compare gastric emptying of tea with milk versus water in pregnant women.