Prevalence and Factors Associated With High-Risk Gastric Contents in Women Admitted to the Maternity Unit for Childbirth: A Prospective Multicenter Cohort Study

( Br J Anaesth . 2024;132:553–561. DOI: 10.1016/j.bja.2023.11.043) To avoid the complication of pulmonary aspiration of gastric complications in an obstetrical setting where anesthesia is administered it is advantageous to identify patients with high-risk gastric contents, usually with a gastric ultrasound. However, this technique can be time-consuming, which is not congruent with obstetric emergencies where care is urgently necessary. Therefore, the primary aim of this study is to identify prevalence of high-risk gastric contents in cases of spontaneous labor, in order that caution may be used in these situations. The hypothesis was that about 50% of women admitted for spontaneous labor would have high-risk gastric contents. Secondary purposes of the study included: (1) the investigation of the prevalence of high-risk gastric contents in women who were not admitted for spontaneous labor and instead a case of induction, elective cesarean delivery (CD), or emergency CD; (2) the determination of alternate characteristics of women with high gastric contents; (3) determine when an ultrasound is a suitable technique for investigating gastric contents. The study was designed as a prospective observational cohort study, with patients from 6 different health centers within France. The study was performed between the months of December 2019 and May 2021. The participating physicians (9) were each well experienced in gastric ultrasounds (<50). The participating patients were all 18 years or older and were admitted to the hospital for labor and delivery. Gastric ultrasounds occurred within the first hour of admission, which was before any epidural or spinal anesthesia was administered. Gastric ultrasounds were performed in the supine and right lateral positions. Measurements of the antrum, including longitudinal, D1, and anteroposterior, D2, were taken, and then the gastric contents were calculated using an algorithm designed for the study. Patient characteristics were identified and included within the study.