Ultrasonography Assesses Gastric Aspiration Risk During Labor

By Will Boggs MD

February 10, 2014

NEW YORK (Reuters Health) - Bedside ultrasonography easily assesses individual risk of gastric content aspiration during labor, researchers from France report.

"This measurement could help in anesthesia management," Dr. Aurelien Bataille from Hopital Tenon, Hopitaux universitaires Est Parisien told Reuters Health by email. "Emergency is the current environment of general anesthesia during labor. If this situation can be anticipated, gastric ultrasonography could help in risk assessment."

Ultrasonographic antral cross-sectional area (CSA) has been shown to correlate with predicted gastric volume, but until now this method had been reported in only two studies of pregnant women with only a total of 10 patients.

Dr. Bataille and colleagues investigated the feasibility of ultrasonographic antral CSA measurement in 60 laboring pregnant women under epidural analgesia and assessed changes in gastric volume during labor.

They used 320 sq mm as the cut-off value for a stomach at risk, according to the January 8th British Journal of Anaesthesia online report.

The overall feasibility rate of antral CSA measurement was 96%, though reproducibility was only 13%.

Median antral CSA was 319 sq mm at epidural insertion and 203 sq mm at full cervical dilatation, and the median change was 51 sq mm over a median 188 minutes.

Half the women had antral CSA above the 320 sq mm cut-off at epidural insertion, vs only seven of 52 (13%) at full cervical dilatation. Moreover, none of the 29 women with antral CSA below the cut-off at epidural insertion had an antral CSA above the cut-off at full cervical dilatation.

"According to this cut-off value for antral CSA, 50% of women initiating labor had a stomach likely to increase the risk of aspiration during anesthesia, despite a median duration of fasting of six hours for liquids and 14 hours for solids before the first measurement," the researchers note. "This finding supports the published observation that gastric mobility might slow down in early labor in pregnant women at term."

However, they add, by the end of the first stage of labor, "nearly 90% of parturients were at reduced risk of inhaling gastric content, had they required general anesthesia."

"Measurement of antral CSA is feasible (and easy, but we haven't prove it yet!) in pregnant women, and gastric motility may be preserved during labor under epidural analgesia," Dr. Bataille concluded.

"I hope research about gastric ultrasonography will spread the technique in the anesthesiologist community," Dr. Bataille added. "Fasting in anesthesia deserves a specific assessment tool."

SOURCE: http://bit.ly/Nfq1tA

Br J Anaesth 2014.

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