Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved]
Background Pulmonary aspiration of gastric contents is the most frequent cause of death associated with complications of airway management during general anaesthesia. Pregnancy increases aspiration risk owing to factors including delayed gastric emptying and increased intragastric pressure. We descr...
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2025-01-01
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| author | Ruth Tunn Marian Knight Alison Gooda Nuala Lucas |
| author_facet | Ruth Tunn Marian Knight Alison Gooda Nuala Lucas |
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| description | Background Pulmonary aspiration of gastric contents is the most frequent cause of death associated with complications of airway management during general anaesthesia. Pregnancy increases aspiration risk owing to factors including delayed gastric emptying and increased intragastric pressure. We describe the incidence, risk factors, management, and outcomes of maternal pulmonary aspiration in pregnancy in the UK. Methods We conducted a population-based surveillance and case-control study. Between September 2013 and August 2016, all UK consultant-led obstetric units prospectively identified cases of pulmonary aspiration among parturient women using a pre-defined case definition, and reported them via the UK Obstetric Surveillance System (UKOSS). Controls (n=1982) were obtained from four UKOSS studies conducted between 2005 and 2014. We calculated the incidence of pulmonary aspiration using 2013–2015 maternities as the denominator. We explored potential risk factors for aspiration using univariable logistic regression and described outcomes. Results We identified 12 cases of pulmonary aspiration, giving an incidence of 5.2 per 1,000,000 maternities (95% CI 2.69-9.09). Cases were significantly less likely than controls to be multiparous (unadjusted odds ratio [uOR] 0.255, 95% CI 0.069-0.946), and significantly more likely to undergo caesarean section (uOR 24.89, 95% CI 3.18-194.85) and to receive general anaesthetic for caesarean section (p<0.001). Gestation was significantly shorter in cases than controls (uOR 0.782, 95% CI 0.702-0.870). Women who aspirated were significantly more likely to be admitted to the intensive therapy unit than controls (p<0.001). Infants of women who aspirated had significantly lower Apgar scores and were more likely to be admitted to the neonatal intensive care unit or to be stillborn compared with infants of women in the control group. Conclusions Pulmonary aspiration is rare in UK obstetric anaesthetic practice; however, it remains a risk of general anaesthesia. Despite a large study population, our analyses lacked power to evaluate many potential risk factors. Future research should focus on developing methods to accurately identify pregnant women at risk of aspiration. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-89e4d59a6cfb40f9bad077006036fe9f2025-02-05T01:00:00ZengF1000 Research LtdNIHR Open Research2633-44022025-01-01514988Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved]Ruth Tunn0https://orcid.org/0000-0003-1187-1808Marian Knight1https://orcid.org/0000-0002-1984-4575Alison Gooda2Nuala Lucas3National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UKNational Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UKNational Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UKLondon North West Healthcare NHS Trust, Watford Road, Harrow, Middlesex, HA1 3UJ, UKBackground Pulmonary aspiration of gastric contents is the most frequent cause of death associated with complications of airway management during general anaesthesia. Pregnancy increases aspiration risk owing to factors including delayed gastric emptying and increased intragastric pressure. We describe the incidence, risk factors, management, and outcomes of maternal pulmonary aspiration in pregnancy in the UK. Methods We conducted a population-based surveillance and case-control study. Between September 2013 and August 2016, all UK consultant-led obstetric units prospectively identified cases of pulmonary aspiration among parturient women using a pre-defined case definition, and reported them via the UK Obstetric Surveillance System (UKOSS). Controls (n=1982) were obtained from four UKOSS studies conducted between 2005 and 2014. We calculated the incidence of pulmonary aspiration using 2013–2015 maternities as the denominator. We explored potential risk factors for aspiration using univariable logistic regression and described outcomes. Results We identified 12 cases of pulmonary aspiration, giving an incidence of 5.2 per 1,000,000 maternities (95% CI 2.69-9.09). Cases were significantly less likely than controls to be multiparous (unadjusted odds ratio [uOR] 0.255, 95% CI 0.069-0.946), and significantly more likely to undergo caesarean section (uOR 24.89, 95% CI 3.18-194.85) and to receive general anaesthetic for caesarean section (p<0.001). Gestation was significantly shorter in cases than controls (uOR 0.782, 95% CI 0.702-0.870). Women who aspirated were significantly more likely to be admitted to the intensive therapy unit than controls (p<0.001). Infants of women who aspirated had significantly lower Apgar scores and were more likely to be admitted to the neonatal intensive care unit or to be stillborn compared with infants of women in the control group. Conclusions Pulmonary aspiration is rare in UK obstetric anaesthetic practice; however, it remains a risk of general anaesthesia. Despite a large study population, our analyses lacked power to evaluate many potential risk factors. Future research should focus on developing methods to accurately identify pregnant women at risk of aspiration.https://openresearch.nihr.ac.uk/articles/5-2/v1pulmonary aspiration incidence pregnancy surveillance UK Obstetric Surveillance Systemeng |
| spellingShingle | Ruth Tunn Marian Knight Alison Gooda Nuala Lucas Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] NIHR Open Research pulmonary aspiration incidence pregnancy surveillance UK Obstetric Surveillance System eng |
| title | Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] |
| title_full | Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] |
| title_fullStr | Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] |
| title_full_unstemmed | Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] |
| title_short | Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study [version 1; peer review: 2 approved] |
| title_sort | pulmonary aspiration during pregnancy or immediately postpartum in the uk a population based case control study version 1 peer review 2 approved |
| topic | pulmonary aspiration incidence pregnancy surveillance UK Obstetric Surveillance System eng |
| url | https://openresearch.nihr.ac.uk/articles/5-2/v1 |
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