title: Ultrasonographic evaluation of gastric content during labour under epidural analgesia: a prospective cohort study.
abstract: BACKGROUND
  Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography.
  
  
  METHODS
  The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil.
  
  
  RESULTS
  After liquid ingestion, antral CSA (mm(2)) increased from 90 (range, 80-151) to 409 (range, 317-463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158-Q3 469] to 203 [Q1 123-Q3 261] during labour (P=2×10(-7)). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation (P=0.006).
  
  
  CONCLUSIONS
  Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour.
authors.affiliation: Hôpital Tenon, Hôpitaux universitaires Est Parisien, Service d'Anesthésie-Réanimation, 4, rue de la Chine, 75020 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Bataille
authors.forename: J
authors.initials: J
authors.lastname: Rousset
authors.forename: E
authors.initials: E
authors.lastname: Marret
authors.forename: F
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016362:Analgesia, Obstetrical / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D005766:Gastrointestinal Contents; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology*; D019095:Point-of-Care Systems; D011247:Pregnancy; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult
keywords: anaesthesia, obstetric; gastrointestinal tract, volume; measurement techniques, ultrasound