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Ultrasound assessment of gastric content in the immediate postpartum period: a prospective observational descriptive study
Author(s) -
Vial F.,
Hime N.,
Feugeas J.,
Thilly N.,
Guerci P.,
Bouaziz H.
Publication year - 2017
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12930
Subject(s) - medicine , vaginal delivery , stomach , childbirth , sedation , observational study , pregnancy , postpartum period , gastric content , antrum , complication , prospective cohort study , anesthesia , surgery , obstetrics , genetics , biology
Pulmonary aspiration of gastric contents in pregnant women undergoing general anesthesia or sedation/analgesia in the peripartum period is a feared complication in obstetric anesthesia. We assessed the changes in antral cross‐sectional area ( CSA ) with ultrasonography in laboring women and in the immediate postpartum period. Patients and methods In an observational study in a university‐affiliated maternity, gastric ultrasonography examinations were performed in non‐consecutive laboring women, after epidural analgesia insertion and after childbirth. Assessment of antral CSA , difficulty of performance on a numerical scale, and factors that could influence gastric content were noted. A cut‐off value of 381 mm 2 was taken for the diagnosis of empty stomach. Results One hundred women were enrolled in the study. Median antral CSA was 469 mm 2 [25th–75th] [324–591] after epidural insertion and 427 mm 2 [316–574] after delivery. Antral CSA was ≥ 381 mm 2 in 59 of 90 women (65%) after epidural insertion vs. 48 of 100 women (48%) after delivery ( P = 0.59). Median variation of antral CSA between two measurements was 36 mm 2 [−42 to 114]. Gastric ultrasonography was significantly more difficult to perform during labor than immediately post‐delivery (median difficulty score 5 [2–7] vs. 2 [1–4], P < 0.0001). No risk factors (pain, anxiety, diabetes, smoking) were significantly associated with the occurrence of full stomach post‐delivery. Conclusion This study demonstrated that 48% of parturients in the immediate postpartum period presented an antral CSA ≥ 381 mm 2 , cut‐off being accepted for diagnosis of empty stomach and emphasizes the need for re‐assessing before any general anesthetic procedure.