Evaluation of gastric contents using ultrasound in full-term pregnant women for elective caesarean section fasted for eight hours : A cohort study / Ramy Melad Ramzy Aziz ; Supervised Amany Said Mahmoud Arafa , Ahmed Mohammed Ibrahim Hasanin , Hany Mohammed Elhadi Shoukat

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Anesthesia

Background Pregnant women are classically known to have a higher risk of pulmonary aspiration of gastric contents due to mechanical displacement of the stomach as well as the relaxation of the lower esophageal sphincter. We aimed to evaluate the gastric content of full-term, non- laboring, pregnant women at 8 hours fasting after a light meal Methods In this prospective observational study, full-term pregnant women aged between 18-40 years were included. Gastric antrum Ultrasound examination was done in all women at 8-hours fasting after the consumption of light meal in both semi-recumbent and right lateral positionThe primary outcome was the proportion of patients with gastric residual volume above 1.5 mL/Kg in the semi-sitting position. Secondary outcomes included antral cross-sectional area, gastric residual volume, and grade of aspiration risk (frequency of high-risk gastric volume [>1.5 mL/kg] and low-risk gastric volume [<1.5 mL/kg]) in both positions. Qualitative grading for assessment of gastric antrum was evaluated as grade 0: Empty antrum, grade 1: minimal fluid detected in right lateral position only, Grade 2: distended antrum. Results Forty-six women with mean age of 31 ±5 years were available for the final analysis. The median (quartiles) antral CSA in the semi-recumbent and the right lateral positions were 214 (152, 266) mm² and 368 (315, 463) mm², respectively. In the semi-recumbent position, the estimated gastric volume did not exceed 1.5 ml/kg, while in the right lateral position, only one woman had an estimated gastric volume >1.5 ml/kg.The presence of solid food was not observed in any of the included women. Antral grade 0, 1 and 2 were identified in 5 (11%), 39 (89%) and 1 (2.2%) women, respectively. Conclusion After an 8-hour fasting period following a light meal, full-term pregnant non-laboring women are likely to have a residual gastric volume lower than the cutoff value for aspiration risk

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