Prevalence and prediction of higher estimated gastric content in parturients at full cervical dilatation: A prospective cohort study

Desgranges, François-Pierrick; Simonin, Marine; Barnoud, Sophie; Zieleskiewicz, Laurent; Cercueil, Eloïse; Erbacher, Julien; Allaouchiche, Bernard; Chassard, D.; Bouvet, Lionel

doi:10.1111/aas.13220

Cited by 16 publications

(9 citation statements)

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“…Epidural analgesia may affect gastric emptying of a meal in two opposite ways: on the one hand, it minimizes the acute pain related to gastroparesis via pain relief, and on the other hand, it reduces gastric motility and delays gastric emptying due to the epidural opioid infusion. 7,8,10 In our study, pain scores were significantly higher in the Parturient-No-Epidural group than they were in the Parturient-Epidural group at each time point. Taken together, the results of the current study suggest that patient-controlled epidural analgesia with a low concentration of ropivacaine and sufentanil significantly improves gastric motility and emptying compared to that seen in natural labor without analgesia.…”

Section: Discussionmentioning

confidence: 41%

“…32,33 It was previously shown that solid food remained in the stomach for many hours after the onset of labor in two thirds of laboring women who received epidural analgesia and that gastric volume was higher in the immediate postpartum period in women who were allowed solid food during labor compared with those who were fasted. 11,34 More recent studies suggest that some gastric motility and emptying persist in laboring women receiving epidural analgesia 9,10 ; however, trials have appropriately assessed neither gastric emptying of a standardized, solid, light meal in parturients nor the effect of epidural analgesia during labor on the gastric emptying of such a meal. Barboni et al 35 recently reported that gastric emptying of a standardized 450-kcal solid meal composed of pasta and meat was delayed in term pregnant women scheduled for cesarean delivery compared with nonpregnant volunteers.…”

Section: Discussionmentioning

confidence: 99%

“…Pain due to uterine contractions and administration of opiates may both affect gastric emptying. 7,8 Although gastric emptying remains to a certain degree during labor, 9,10 the gastric volume was larger within the first hour after delivery in women who were allowed solid food during labor compared to those who fasted for solids. 11 However, to date, no study has appropriately assessed the gastric emptying of a light meal in the parturient.…”

Section: What We Already Know About This Topicmentioning

confidence: 99%

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Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study

et al. 2022

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Background The lack of reliable data on gastric emptying of solid food during labor has led to some discrepancies between current guidelines regarding fasting for solid food in the parturient. This prospective comparative study aimed to test the hypothesis that the gastric emptying rate of a light meal would be reduced in parturients receiving epidural analgesia and with no labor analgesia compared with nonpregnant and pregnant women. Methods Ten subjects were enrolled and tested in each group: nonpregnant women, term pregnant women, parturients with no labor analgesia, and parturients with epidural labor analgesia. After a first ultrasound examination was performed to ensure an empty stomach, each subject ingested a light meal (125 g yogurt; 120 kcal) within 5 min. Then ultrasound measurements of the antral area were performed at 15, 60, 90, and 120 min. The rate of gastric emptying at 90 min was calculated as [(antral area90 min / antral area15 min) – 1] × 100, and half-time to gastric emptying was also determined. For the Parturient–Epidural group, the test meal was ingested within the first hour after the induction of epidural analgesia. Results The median (interquartile range) rate of gastric emptying at 90 min was 52% (46 to 61), 45% (31 to 56), 7% (5 to 10), and 31% (17 to 39) for nonpregnant women, pregnant women, parturients without labor analgesia, and parturients with labor epidural analgesia, respectively (P < 0.0001). The rate of gastric emptying at 90 min was statistically significant and lower in the Parturient–Epidural group than in the Nonpregnant and Pregnant Control groups. In addition, the rate of gastric emptying at 90 min was statistically significant and lower in the Parturient–No-Epidural group than in the Parturient–Epidural group. Conclusions Gastric emptying in parturients after a light meal was delayed, and labor epidural analgesia seems not to worsen but facilitates gastric emptying. This should be taken into consideration when allowing women in labor to consume a light meal. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 99%

Section: What We Already Know About This Topicmentioning

confidence: 99%

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Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study

et al. 2022

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“…Although the definition of a full stomach that increases aspiration risk is somewhat controversial, recent literatures recommend that a full stomach may be defined as any solid or thick particulate content or grade 2, or grade 1 with gastric volume of ≥1.5 ml· kg − 1 under ultrasound examination [ 7 , 10 , 21 ]. Based on this criterion, the incidence (80%) of risk stomach in non-fasted laboring women in this study was significantly higher than the laboring women allowed to drink only in other studies (27 and 48%, respectively) [ 18 , 19 ]. Moreover, the fasting time for solids, but not for liquids, was significantly associated with the antral CSA, suggesting that solid foods have a major contribution of risk stomach during labor.…”

Section: Discussionmentioning

confidence: 53%

Prevalence of risk stomach in laboring women allowed to unrestrictive oral intake: a comparative cross-sectional study

et al. 2022

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Background Although 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. Methods Ultrasound 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. Results No 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). Conclusions This 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.

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“…As in non-pregnant adults, several studies reported a significant relationship between the semiquantitative grading scale and GFV in term pregnant women, with a significant increase in GFV along with this semiquantitative grade. 3,5 However, there are insufficient published data to support the use of this tool in the obstetrical population. Therefore, we performed a secondary analysis of data from three previously published studies to assess the diagnostic performance of the semi-quantitative ultrasound grading system for prediction of GFV in pregnant women at the third trimester.…”

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confidence: 99%

Semi-quantitative ultrasound grading system to discriminate between low and high gastric fluid volume in third-trimester pregnant women

Desgranges

Zieleskiewicz

Chassard

et al. 2021

British Journal of Anaesthesia

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Prevalence and prediction of higher estimated gastric content in parturients at full cervical dilatation: A prospective cohort study

Cited by 16 publications

References 44 publications

Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study

Pregnancy and Labor Epidural Effects on Gastric Emptying: A Prospective Comparative Study

Prevalence of risk stomach in laboring women allowed to unrestrictive oral intake: a comparative cross-sectional study

Semi-quantitative ultrasound grading system to discriminate between low and high gastric fluid volume in third-trimester pregnant women

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