Background and Goal of Study
Fasting recommendations are particularly important in pregnant women due to their increased risk of aspiration. In Basildon Hospital, a medium sized district general hospital, we noted a case of hypoglycaemic collapse in a non-diabetic patient awaiting an elective Caesarean section (LSCS). This was attributed to prolonged fasting times, having no dedicated operating list for elective LSCS. We therefore set up an audit to measure the incidence of hypoglycaemia, introduced measures to reduce this and re-audited to assess any improvement.

Materials and Methods
Non-diabetic patients awaiting LSCS between November 2014 and May 2015 were included in the initial audit. Their blood glucose level and fasting time were recorded. The patients were asked about the presence of hypoglycaemia symptoms.
After discussion at our departmental meeting, consumption of a carbohydrate rich drink two hours before surgery time was chosen as the most suitable intervention to reduce hypoglycaemia and introduced. The audit was repeated between May and October 2016. Data were analysed with SPSS, using independent samples t-test, χ2 test, Pearson correlation and logistic regression.

Results and Discussion
Thirty women were included in the initial audit (group 1). After implementation of our intervention, 32 women were included in the re-audit (group 2). Mean blood glucose levels were 4.0 mmol/L (SD=0.50) in group 1 and 4.1 mmol/L (SD=0.49) in group 2 (t(60)=-1.025, p=0.31). Food fasting time was 16 hours in both groups (t(60) = 0.15, p=0.88 ). Fluid fasting time was 16 hours in group 1 and 15 hours, excluding the carbohydrate drink, in group 2 (t(60) = 0.52, p=0.60). Hypoglycaemic symptoms decreased from 47% to 31% (χ2(1)=1.55, p=0.29). There was a clear correlation in both groups between fluid fasting time and blood sugar value (r=-0.33, p< 0.01), as well as between fluid fasting time and hypoglycaemic symptoms (R2=0.42, p< 0.01).

Conclusion
The incidence of hypoglycaemia in our audit was higher than expected, with 50% having blood glucose levels ≤ 4 mmol/L and 47% with hypoglycaemia symptoms. This was 38% and 31% respectively in our re-audit. Fasting times were much longer than recommended. Being an audit, our study was not powered and did not show any significant improvement. However, the clear correlation between fluid fasting time and blood glucose as well as fasting time shows the potential benefit with stricter implementation of fasting guidelines.

Improving hypoglycaemic control in women awaiting elective Caesarean sections