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Bouvet L, Fabre J, Roussin C, Nadal C, Dezavelle S, Vial F, Le Gouez A, Soued M, Keita H, Zein W, Desgranges FP, Thuet V, Boucekine M, Duclos G, Leone M, Zieleskiewicz L. Prevalence and factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth: a prospective multicentre cohort study. Br J Anaesth 2024; 132:553-561. [PMID: 38177007 DOI: 10.1016/j.bja.2023.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND This multicentre prospective observational study sought to determine the prevalence and the factors associated with high-risk gastric contents in women admitted to the maternity unit for childbirth, and to identify the clinical situations in which ultrasound assessment of gastric contents would be most helpful (i.e. when the prevalence of high-risk gastric contents is close to 50%). METHODS Ultrasound assessments of gastric contents were performed within the first hour after admission to the maternity unit. The prevalence of high-risk gastric contents was calculated and variables associated with high-risk gastric contents were identified using logistic regression analyses. RESULTS A total of 1003 parturients were analysed. The prevalence of high-risk gastric contents was 70% (379/544; 95% confidence interval: 66-74%) in women admitted in spontaneous labour and 65% (646/1003; 95% confidence interval: 61-67%) in the whole cohort. Lower gestational age, increased fasting duration for solids, and elective Caesarean delivery were independently associated with reduced likelihood of high-risk gastric contents. In women admitted in spontaneous labour and in the whole cohort, the prevalence of high-risk gastric contents ranged from 85% to 86% for fasting duration for solids <6 h, 63%-68% for fasting 6-8 h, 54%-55% for fasting 8-12 h, and 47%-51% for fasting ≥12 h. CONCLUSIONS Around two-thirds of parturients had high-risk gastric contents within the first hour after admission to the maternity unit. Our results suggest that gastric emptying for solids continues in labouring women, and that gastric ultrasound would be most helpful when fasting duration is ≥8 h.
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Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France; Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Juliette Fabre
- Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France
| | - Charlotte Roussin
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Camille Nadal
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Dezavelle
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Florence Vial
- Department of Anaesthesiology and Intensive Care, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Agnès Le Gouez
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Mickael Soued
- Department of Anaesthesiology and Intensive Care, Hôpital Antoine Béclère, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Hawa Keita
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Waed Zein
- Department of Anaesthesiology and Intensive Care, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - François-Pierrick Desgranges
- Research Unit APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France; Department of Anaesthesiology and Intensive Care, L'Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Vincent Thuet
- Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mohamed Boucekine
- Department of Biostatistics, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Gary Duclos
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Marc Leone
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Laurent Zieleskiewicz
- Department of Anaesthesiology and Intensive Care, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Bouvet L, Bonnet MP, Keita-Meyer H, Benhamou D. Fasting or eating during labour? It is time to move forward. Anaesth Crit Care Pain Med 2024; 43:101311. [PMID: 37865215 DOI: 10.1016/j.accpm.2023.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Lionel Bouvet
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France, and APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Marie-Pierre Bonnet
- Sorbonne Université, Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Armand-Trousseau hospital, DMU DREAM, APHP, GRC29, Paris, France, and Université Paris Cité, Inserm, Inrae, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), U1153 CRESS, Paris, France
| | - Hawa Keita-Meyer
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Universitaire Necker-Enfants Malades, Paris, France, and Centre - Université de Paris, France, Unité de Recherche EA 7323 Pharmacologie et Evaluation des Thérapeutiques Chez l'Enfant et la Femme Enceinte, Université de Paris, France
| | - Dan Benhamou
- Department of Anaesthesiology, Intensive Care and Perioperative Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, France, and Université Paris Saclay, Paris, France
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Ultrasound assessment of gastric contents prior to placental delivery: A prospective multicentre cohort study. Anaesth Crit Care Pain Med 2021; 41:100993. [PMID: 34890858 DOI: 10.1016/j.accpm.2021.100993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/21/2021] [Accepted: 10/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is ongoing debate regarding the optimal general anaesthetic technique for manual removal of the placenta after vaginal delivery. Using ultrasound examination of the gastric antrum, this study aimed to assess the change in gastric contents during vaginal delivery and to determine the prevalence of stomach at risk for pulmonary aspiration in the immediate postpartum period before placental delivery. METHODS In this prospective multicentre cohort study, antral ultrasonography was performed at full cervical dilatation within the thirty minutes preceding the beginning of expulsive efforts and after vaginal birth, before placental delivery. High-risk gastric content was defined as the visualisation of any solid content in the antrum or antral cross-sectional area in the semi-recumbent position (SR-CSA) > 608 mm². RESULTS Twenty-six women were included and analysed. There was a significant decrease in both the proportion of patients with solid gastric content and the SR-CSA between the two-ultrasound examinations. Twenty-one patients (80.8%) exhibited a decrease in the SR-CSA during vaginal delivery. The prevalence of stomach at risk for pulmonary aspiration was significantly lower after vaginal delivery than before vaginal delivery (23.1% vs. 57.7%, P = 0.0004). CONCLUSION Our results suggest that gastric emptying is at least partially preserved during vaginal birth. Nevertheless, almost a quarter of women did have high-risk gastric content in the immediate postpartum period. Point-of-care antral ultrasonography may be of interest for the fast assessment of the gastric content status when a general anaesthesia is required for manual removal of retained placenta.
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Desgranges FP, Simonin M, Barnoud S, Zieleskiewicz L, Cercueil E, Erbacher J, Allaouchiche B, Chassard D, Bouvet L. Prevalence and prediction of higher estimated gastric content in parturients at full cervical dilatation: A prospective cohort study. Acta Anaesthesiol Scand 2019; 63:27-33. [PMID: 30084204 DOI: 10.1111/aas.13220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/06/2018] [Accepted: 07/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Emergent obstetrical procedures may require general anaesthesia in parturients at full cervical dilatation or immediately after vaginal birth. This study aimed to determine the prevalence and the predictive factors of higher estimated gastric content in parturients at full cervical dilatation with epidural analgesia and allowed to drink during the labour, and to assess the ability of the antral area measured in the semirecumbent position (SR-CSA) to identify higher estimated gastric content in this setting. METHODS This prospective observational study was conducted between December 2016 and July 2017. Ultrasonographic examination of the antrum was performed at full cervical dilatation, within the hour preceding the beginning of expulsive efforts. Higher estimated gastric content was defined when solid content was observed and/or if the calculated gastric fluid volume was >1.5 mL/kg. RESULTS Seventeen of 62 parturients (27%) presented higher estimated gastric content. Maximal pain intensity during the last hour of labour and time interval between the insertion of the epidural catheter and ultrasonographic examination were significantly increased in parturients with higher estimated gastric content. The threshold value of the SR-CSA to identify a higher estimated gastric content was 393 mm2 , with sensitivity = 88% and specificity = 87%. CONCLUSION Around a quarter of parturients with epidural analgesia and free access to clear fluids during labour presented higher estimated gastric content at full cervical dilatation. The SR-CSA may be of interest for the fast ultrasound assessment of the gastric content status in case of emergent obstetrical procedures at full cervical dilatation.
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Affiliation(s)
- François-Pierrick Desgranges
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
| | - Marine Simonin
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Sophie Barnoud
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Laurent Zieleskiewicz
- Department of Anesthesia and Intensive Care; University Hospital of Marseille; Marseille France
| | - Eloise Cercueil
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Julien Erbacher
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
| | - Bernard Allaouchiche
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
- Department of Anesthesia and Intensive Care; Lyon Sud Hospital; Hospices Civils de Lyon; Pierre-Bénite France
| | - Dominique Chassard
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
| | - Lionel Bouvet
- Department of Anesthesia and Intensive Care; Hospices Civils de Lyon; Femme Mère Enfant Hospital; Bron France
- Research Unit APCSe VetAgro Sup UPSP 2016.A101; Claude Bernard Lyon 1 University; Marcy-l'Etoile France
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Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI. Eur J Anaesthesiol 2018; 35:379-389. [DOI: 10.1097/eja.0000000000000749] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vial F, Hime N, Feugeas J, Thilly N, Guerci P, Bouaziz H. Ultrasound assessment of gastric content in the immediate postpartum period: a prospective observational descriptive study. Acta Anaesthesiol Scand 2017; 61:730-739. [PMID: 28653359 DOI: 10.1111/aas.12930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/16/2017] [Accepted: 06/04/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pulmonary aspiration of gastric contents in pregnant women undergoing general anesthesia or sedation/analgesia in the peripartum period is a feared complication in obstetric anesthesia. We assessed the changes in antral cross-sectional area (CSA) with ultrasonography in laboring women and in the immediate postpartum period. PATIENTS AND METHODS In an observational study in a university-affiliated maternity, gastric ultrasonography examinations were performed in non-consecutive laboring women, after epidural analgesia insertion and after childbirth. Assessment of antral CSA, difficulty of performance on a numerical scale, and factors that could influence gastric content were noted. A cut-off value of 381 mm2 was taken for the diagnosis of empty stomach. RESULTS One hundred women were enrolled in the study. Median antral CSA was 469 mm2 [25th-75th] [324-591] after epidural insertion and 427 mm2 [316-574] after delivery. Antral CSA was ≥ 381 mm2 in 59 of 90 women (65%) after epidural insertion vs. 48 of 100 women (48%) after delivery (P = 0.59). Median variation of antral CSA between two measurements was 36 mm2 [-42 to 114]. Gastric ultrasonography was significantly more difficult to perform during labor than immediately post-delivery (median difficulty score 5 [2-7] vs. 2 [1-4], P < 0.0001). No risk factors (pain, anxiety, diabetes, smoking) were significantly associated with the occurrence of full stomach post-delivery. CONCLUSION This study demonstrated that 48% of parturients in the immediate postpartum period presented an antral CSA ≥ 381 mm2 , cut-off being accepted for diagnosis of empty stomach and emphasizes the need for re-assessing before any general anesthetic procedure.
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Affiliation(s)
- F. Vial
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - N. Hime
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - J. Feugeas
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
| | - N. Thilly
- Clinical Epidemiology and Evaluation; University Hospital of Nancy; Nancy France
| | - P. Guerci
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
- Department of Anesthesiology and Critical Care Medicine; University Hospital of Nancy; Nancy France
- University of Lorraine; Nancy France
| | - H. Bouaziz
- Department of Anesthesiology and Obstetric Critical Care Unit; Maternity Hospital; Nancy France
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Determination of a cut-off value of antral area measured in the supine position for the fast diagnosis of an empty stomach in the parturient. Eur J Anaesthesiol 2017; 34:150-157. [DOI: 10.1097/eja.0000000000000488] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zieleskiewicz L, Boghossian M, Delmas A, Jay L, Bourgoin A, Carcopino X, Poirier M, Cogniat B, Stewart A, Chassard D, Leone M, Bouvet L. Ultrasonographic measurement of antral area for estimating gastric fluid volume in parturients. Br J Anaesth 2016; 117:198-205. [DOI: 10.1093/bja/aew171] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 11/14/2022] Open
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Prise en charge initiale par l’anesthésiste-réanimateur d’une hémorragie du post-partum dans les suites d’un accouchement par voie basse. ACTA ACUST UNITED AC 2014; 43:1009-18. [DOI: 10.1016/j.jgyn.2014.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Gestion des voies aériennes en obstétrique. ACTA ACUST UNITED AC 2011; 30:651-64. [DOI: 10.1016/j.annfar.2011.03.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 03/24/2011] [Indexed: 11/21/2022]
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Zoumenou E, Denakpo JL, Kaboro M. Protection des voies aériennes en obstétrique: étude des pratiques dans une maternité universitaire du Bénin. Can J Anaesth 2010; 57:1127-8. [DOI: 10.1007/s12630-010-9383-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 08/30/2010] [Indexed: 10/19/2022] Open
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Mantz J. [Key original articles published in the Annales françaises d'anesthésie et de réanimation (years 2008-2009)]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2010; 29:36-38. [PMID: 20080011 DOI: 10.1016/j.annfar.2009.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 11/27/2009] [Indexed: 05/28/2023]
Affiliation(s)
- J Mantz
- Service d'anesthésie-réanimation Smur, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Diemunsch P, Mercier FJ, Noll E. [Obstetric anaesthesia for instrumental vaginal delivery]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2008; 37 Suppl 8:S269-S275. [PMID: 19268203 DOI: 10.1016/s0368-2315(08)74764-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The aim of the anaesthesia for instrumental delivery is to provide optimal operation conditions for the obstetrician, appropriate maternal comfort, altogether with safety for the mother and her foetus. The type and location for this intervention are chosen individually for each case according to the indication, the risk of caesarean section and the local specificities. The general safety recommendations for obstetric anaesthesia apply in every case. Since an epidural analgesia is often already working, this type of anaesthesia is the most frequently used for the extractions. A spinal anaesthesia is a logical choice where an epidural in sot yet working. The pudendal block is a second line choice and the general anaesthesia remains as the last alternative in acute emergencies, in cases of failed regional anaesthesia or when the mother refuses any other anaesthesia despite proper information or proves unable to cooperate.
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Affiliation(s)
- P Diemunsch
- Hôpital de Hautepierre, service d'anesthésie-réanimation chirurgicale, 1, av. Molière, 67098 Strasbourg cedex, France.
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