Key result
Term pregnancy reduced ultrasound visibility of the gastric antrum in the supine position compared to nonpregnant patients (82% vs 100%, P=0.014).
Why the study?
Pregnant patients undergoing anesthesia are at increased risk of aspiration, and bedside ultrasound measurement of gastric volume before elective cesarean section may help reduce aspiration-induced morbidity and mortality.
Does ultrasound-measured gastric cross-sectional area differ between term-pregnant patients and nonpregnant patients immediately before elective surgery?
Case-Control (n=63)
Does ultrasound-measured gastric cross-sectional area differ between term-pregnant patients and nonpregnant patients immediately before elective surgery?
Absolute Event Rate: 82% vs 100%
p-value: p=0.014
The gravid uterus can impede ultrasound visualization of the gastric antrum in term pregnant patients, but gastric cross-sectional area is clinically similar to nonpregnant patients.
May support gastric ultrasound for pre-CS risk stratification; leaves open impact on aspiration outcomes.
Background: The pregnant patients undergoing anesthesia are at increased risk of aspiration due to decreased lower esophageal sphincter tone and mass effect of gravid uterus on gastric antrum. Ultrasound used as a noninvasive bedside imaging tool to measure gastric volume in term pregnant patients immediately before elective caesarian section (CS) may help in reducing aspiration induced morbidity and mortality. Methods: This observational prospective case--control study was conducted in 33 nonlaboring term pregnant patients immediately before elective CS and 30 nonpregnant patients immediately before elective surgeries, enrolled according to inclusion and exclusion criteria. A 2-5 MHz curvilinear probe was used to scan the participants in supine and right lateral decubitus (RLD) position in pre-recovery room. Visibility, qualitative grading (0,1, 2), anteroposterior (AP), and craniocaudal (CC) diameter, and cross-sectional area (CSA) of gastric antrum was measured. Gastric volume was derived from CSA using equations formulated by previous investigators. Results: Gastric antrum was visible in 27 (82%) of pregnant and 30 (100%) of nonpregnant patients in supine position ( P = 0.014). In RLD position, 25 (75.7%) pregnant and 29 (96.7%) nonpregnant patients had antrum visible ( P = 0.018). The qualitative grading was comparable ( P = 0.064) in both the groups. In supine position, ( P = 0.615), CSA in cm 2 was 3.37 ± 1.31 and 3.54 ± 1.33, while in RLD position ( P = 0.012), CSA was 3.98 ± 1.13 and 5.09 ± 1.85, in pregnant and nonpregnant patients, respectively. Conclusion: Gravid uterus sometimes impedes visualization of antrum by ultrasound in term pregnant patients immediately before elective CS and shows clinically similar gastric CSA when compared to nonpregnant patients, though statistically different in RLD position. Trial registration number- NCT03380637
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Bellapukonda et al. (2023) conducted a case-control in Term pregnancy requiring elective cesarean section (n=63). Term pregnancy vs. Nonpregnant state was evaluated on Gastric antrum visibility in supine position (p=0.014). Term pregnancy reduced ultrasound visibility of the gastric antrum in the supine position compared to nonpregnant patients (82% vs 100%, P=0.014).
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