Abstract
BackgroundAlthough restricting food intake during labor is recommended by guidelines, intrapartum starvation has not been popular in some regions. We conducted this comparative cross-sectional study to determine the prevalence of risk stomach in non-fasted laboring women compared with fasted non-laboring women using gastric ultrasound.MethodsUltrasound examination of the antrum was performed in 50 term fasted non-laboring women before elective cesarean delivery and 50 laboring women allowed to eat and drink during active labor. Examinations consisted of the qualitative (antral grades, 0–3) and quantitative evaluation (antral cross-sectional area and calculated gastric volume) in the supine and right lateral decubitus (RLD) position. A risk stomach was defined as an antral grade ≥ 2 or grade 1 with gastric volume ≥ 1.5 ml· kg− 1.ResultsNo non-laboring women had grade ≥ 2, while 34 (68%) laboring women had grade ≥ 2. Nine (18%) non-laboring and 40 (80%) laboring women presented risk stomach (P < 0.001) (risk ratio: 4.4, 95% CI 2.4–8.2). Compared with non-laboring women, laboring women had larger antral area at “empty” stomach (grade 0) (437 mm2 vs.350 mm2 in supine, 571 mm2 vs.480 mm2 in RLD, P < 0.05) and cut-off values of antral area to discriminate a risk stomach (510 mm2 vs. 453 mm2 in supine, 670 mm2 vs. 605 mm2 in RLD).ConclusionsThis study confirms a higher prevalence of risk stomach presents in laboring women under a liberal eating policy, gastric ultrasound is therefore useful for this risk population if general anesthesia is required unexpectedly.
Highlights
Restricting food intake during labor is recommended by guidelines, intrapartum starva‐ tion has not been popular in some regions
Background regional anesthesia is preferentially used for most obstetric procedures in obstetric anesthetic practice, [1] there are still some situations in which general anesthesia may be necessary, especially in case of emergency cesarean delivery during labor
Gastric ultrasound is a valuable tool for the assessment of gastric contents and volume in obstetric anesthesia, [7] including non-laboring [8,9,10,11,12,13,14] and laboring women [15,16,17,18,19]
Summary
Restricting food intake during labor is recommended by guidelines, intrapartum starva‐ tion has not been popular in some regions. We conducted this comparative cross-sectional study to determine the prevalence of risk stomach in non-fasted laboring women compared with fasted non-laboring women using gastric ultrasound. There is insufficient information regarding the impact of such a liberal eating policy on the gastric contents in laboring women. We conducted this comparative cross-sectional study to determine the prevalence of risk stomach in term non-fasted laboring women compared with fasted non-laboring women using ultrasound examination of the antrum. We estimated the ability of antral cross-sectional area (CSA) to identify a risk stomach in this setting
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