ÿWPCZ xí‰2 Sq'Bn†cvï$~H4…Ó^µ´‰¾(/«¯bÙ£KWÃëêÔûç­{ÅïЬm;Ø$ŠÛMJ¯Ë„üƒÏÝú ®loqàØ*œ&{h7Hõ ÂW!G©K1Á['ë´²]Î0¸õ¿oâK}ÕM‘ôžâ¥‰ïQåÒ4¦Ï¥Žæ+Ö /Jš:¯7÷á á)e¼¾–‰•Q:.UšuÞö;ü_Oâ$VðôÕifý_5ä]51XÞš–HZWûVü„ÞçJ&hH¬<ÞÆÃF®=¹B€8N¸?‰ Tô'\ʳQ [@ƒ™QÎRsžÞ°Ïz‚ýGua§1ò’»’ DˆÜó+غ G–²ñ\©ãÔܯŽú€–9Ôm¥LÑ ï—\ñô\Ú/ -ØZ¹T¼*º¤Sd+¾‰%`\®Œ¦]QÊl„*Å §ð{sÖØ üÂãŠöºv˜Ì‡.é»gž,iŠ-W÷¸PC?耢G[£†+d¸5ú©ý¨UXÐo³dŸãÇæÖÝñžA¹t`C‡þÉ­aÌeL·òÇ;úÐè¡//„µÃ×vCÐÒÈ7›4–Ô ˆ_ÃôèhÀz%@Ó ã®F&둦vëÎÏ`‹ª¨¿a9?þ‰µl…f# pUN{ %É 0(Ïw@÷47K˜HP LaserJet 5P/5MPHPPCL5G,ä,,,,,ä0^Wb(ÈhH  Z ‹6Times New Roman RegularX($¡¡ ‚Eƒ„U…U†£‡£ˆ‰UŠ£8‰È"úÿÿú, ú3|xŠÝ ƒ!ÝÝ  Ýñ‡ñÓ  Óñ‡ññˆñSubject:€ñˆñFood€and€drink€for€obstetric€patientsñ‰ñÌñ‰ñÌñ‡ññ†ñÓ  Óñ†ññ‡ñJoint€Statement€of€Obstetrics€and€Obstetric€Anesññthesia€ñññ„ñÌñ„ñññat€ñññ…ñÌñ…ñññOregon€Heñññ‚ñññlañññ‚ññƒñalth€Sciences€UniversityñƒñÌñ‡ññ†ñÓOÓñ†ññ‡ñÌñŠñÓ  ÓñŠñ€€€Prior€to€making€òòanyóó€decision€regarding€this€issue€for€obstetric€patients,€it€is€important€toÐ P   Ðevaluate€the€patient€in€regard€to€her€risk€for€cesarean€section.€Food€and/or€drink€are€only€aÏproblem€if€the€patient€subsequently€requires€surgery;€while€we€can€never€hope€to€identify€allÏwomen€who€will€need€a€section,€a€reasonable€clinical€evaluation€will€pick€up€a€large€proportion.ÏA€woman€admitted€with€late€decelerations€on€a€CST€done€for€IUGR€and€oligohydramnios,€forÏexample,€would€certainly€be€considered€to€be€at€high€risk,€while€a€woman€at€term€with€herÏsecond€normal„sized€infant€would€be€at€low€risk.€We€would€like€to€see€a€comment€to€this€effectÏ(e.g.€ð ðRisk€for€C/S:€[high,€moderate,€low]ðð)€entered€into€the€assessment€on€the€history€andÏphysical.€Ì€€Patients€at€high€risk€should€not€receive€òòanyóó€food€or€liquid€by€mouth;€it€will€only€complicateÐ À Ðtheir€care.€Moderate€risk€should€indicate€a€need€for€further€assessment,€and€the€patient€shouldÏremain€NPO€until€conditions€are€more€clear.€Patients€at€low€risk€may€be€given€clear€liquidsÏthroughout€their€labor.€Food€(anything€beyond€clear€liquids)€should€not€be€a€part€of€our€normalÏofferings,€and€should€only€be€given€to€a€patient€if€a€careful€clinical€evaluation€identifies€a€womanÏwho€is€not€felt€to€be€at€risk€for€active€labor€and/or€a€need€for€rapid€delivery€within€the€near€future.ÏWhile€this€is€a€somewhat€fuzzy€statement,€it€is€meant€to€require€evaluation€by€a€physician,€and€aÏspecific€order€in€the€chart€before€such€food€may€be€given.€It€does€not€seem€reasonable€to€provideÏfood€under€virtually€any€circumstances€to€a€woman€in€òòactiveóó€labor,€as€a€need€for€intervention€isÐ @ Ðso€hard€to€predict€during€this€phase.€Ì€€The€same€reasoning€should€be€used€for€hospitalized€antepartum€patients.€If,€for€example,€aÏwoman€with€a€chronic€abruption€begins€to€bleed,€then€until€things€have€stabilized,€she€is€at€highÏrisk€for€a€cesarean€section,€and€should€have€all€food€and€drink€withheld.Ì€€Labor€is€òònotóó€a€pathologic€process;€the€risk€of€a€maternal€death€related€to€anesthesia€is€currentlyÐ ð@ Ðapproximately€1:100,000€births.€It€is€our€job€to€support€the€vast€majority€of€women€through€thisÏnormal€event€while€not€adding€to€the€risk€of€the€unfortunate€minority€who€do€get€into€trouble.€AÏòòprospectiveóó€assessment€of€the€patient€can€help€accomplish€this.Ð À! ÐÌñŠñÓ„ÓñŠñ