Preoperative Gastric Volume Assessment in Full-Term Pregnant and Non-Pregnant Females: A Prospective Observational Study
Downloads
Introduction: Perioperative pulmonary aspiration (PA) of gastric contents is a serious anesthetic complication that can lead to significant morbidity and mortality. Obstetric patients, due to substantial anatomical and physiological changes, face a significantly higher risk of PA compared to non-pregnant individuals undergoing planned gynecological or other procedures.
Objective: The objective of this study is to compare gastric contents and volume through point-of-care gastric ultrasound (PoCUS) in full-term pregnant women and non-pregnant females scheduled for elective surgeries.
Methods: This single-center, prospective, observational study included 140 patients who underwent surgery between March 2022 and July 2023. Quantitative and qualitative measurements of the stomach were performed using PoCUS.
Results: The study included 140 patients with a mean age of 25±2.5 years (pregnant, range: 22-31 years) and 29±6 years (non-pregnant, range: 21-30 years), respectively. Patients in the pregnant group are classified as ASA II (70 (100%)), while those in the non-pregnant group (ASA I: 22 (31%); ASA II: 48 (69%)) are mixed. In Perlas, a 3-point grading system was used to classify the antrum based on the presence or absence of clear fluid in the supine position. The majority of the pregnant patients’ antrum levels were reported to contain clear fluid (37 (53%)), while in non-pregnant patients, they were empty (45 (64%)). The average gastric antrum cross-sectional area (302.63±4.87 cm2) and gastric volume (1.85±0.5 mL) were found to be high in pregnant females.
Conclusion: PoCUS was proven to be a simple, non-invasive method that can evaluate and offer a more precise bedside measurement of gastric volume, both qualitatively and quantitatively, in patients at risk for PA.
Khan SA, Sahoo TK, Trivedi S. Comparative ultrasound-guided assessment of gastric volume between diabetic and non-diabetic patients posted for elective surgery—a prospective, observational, correlation study. Ain-Shams J Anesthesiol 2023. 2023; 15(1): 1–6.
Sussane A. Pulmonary aspiration in perioperative medicine. Acta Anaesthesiol Belg. 2013; 64(1): 1-13.
Kruisselbrink R, Gharapetian A, Chaparro LE, Ami N, Richler D, Chan VWS, et al. Diagnostic Accuracy of Point-of-Care Gastric Ultrasound. Anesth Analg. 2019; 128(1): 89–94.
Zdravkovic M, Berger-Estilita J, Kovacec JW, Sorbello M, Mekis D. A way forward in pulmonary aspiration incidence reduction: ultrasound, mathematics, and worldwide data collection. Brazilian J Anesthesiol (English Ed. 2023; 73(3): 301–4.
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective ProceduresAn Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017; 126(3): 376–93.
Van De Putte P, Perlas A. Ultrasound assessment of gastric content and volume. Br J Anaesth. 2014; 113(1): 12–22.
Doctor J, Chandan P, Shetty N, Gala K, Ranganathan P. Ultrasound-guided assessment of gastric residual volume in patients receiving three types of clear fluids: A randomised blinded study. Indian J Anaesth. 2021; 65(4): 289–94.
Kaydu A, Gokcek E. Preoperative Assessment of Ultrasonographic Measurement of Antral Area for Gastric Content. Med Sci Monit. 2018; 24: 5542.
Zieleskiewicz L, Boghossian MC, Delmas AC, Jay L, Bourgoin A, Carcopino X, et al. Ultrasonographic measurement of antral area for estimating gastric fluid volume in parturients. Br J Anaesth. 2016; 117(2): 198–205.
Bisinotto FMB, Naves A de A, Lima HM de, Peixoto ACA, Maia GC, Junior PPR, et al. Use of ultrasound for gastric volume evaluation after ingestion of different volumes of isotonic solution. Brazilian J Anesthesiol (English Ed. 2017; 67(4): 376–82.
Perlas A, Mitsakakis N, Liu L, Cino M, Haldipur N, Davis L, et al. Validation of a mathematical model for ultrasound assessment of gastric volume by gastroscopic examination. Anesth Analg. 2013; 116(2): 357–63.
Perlas A, Davis L, Khan M, Mitsakakis N, Chan VWS. Gastric sonography in the fasted surgical patient: a prospective descriptive study. Anesth Analg. 2011; 113(1): 93–7.
Warner MA, Meyerhoff KL, Warner ME, Posner KL, Stephens L, Domino KB. Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis. Anesthesiology. 2021; 135(2): 284–91. [Website]
Lucas DN, Elton CD. Through a glass darkly – ultrasound imaging in obstetric anaesthesia. Anaesthesia. 2016; 71(6): 617–22.
Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, et al. Perioperative Ultrasound Training in Anesthesiology: A Call to Action. Anesth Analg. 2016; 122(6): 1794–804.
Benhamou D. Ultrasound assessment of gastric contents in the perioperative period: why is this not part of our daily practice? Br J Anaesth. 2015; 114(4): 545–8.
Weiniger CF, Sharoni L. The use of ultrasound in obstetric anesthesia. Curr Opin Anaesthesiol. 2017;30(3):306–12.
Chaitra TS, Palta S, Saroa R, Jindal S, Jain A. Assessment of residual gastric volume using point-of-care ultrasonography in adult patients who underwent elective surgery. Ultrasound J. 2023; 15(1): 1–9.
Clark K, Lam LT, Gibson S, Currow D. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials. Anaesthesia. 2009; 64(6): 652–7.
Arzola C, Perlas A, Siddiqui NT, Carvalho JCA. Bedside Gastric Ultrasonography in Term Pregnant Women before Elective Cesarean Delivery: A Prospective Cohort Study. Anesth Analg. 2015; 121(3): 752–8.
Amaral CK, Benevides ML, Benevides MM, Sampaio DL, Fontes CJF. Ultrasound assessment of gastric antrum in term pregnant women before elective cesarean section. Brazilian J Anesthesiol. 2019; 69(3): 266–71.
Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anaesthesia. 1999; 83(3): 453–60.
Khalil AM, Ragab SG, Botros JM, Boules ML, Abd-Aal HA. Gastric Residual Volume Assessment by Gastric Ultrasound in Fasting Obese Patients: A Comparative Study. Anesthesiol pain Med. 2021; 11(1): 1–7.
Van de Putte P, Vernieuwe L, Perlas A. Term pregnant patients have similar gastric volume to non-pregnant females: a single-centre cohort study. Br J Anaesth. 2019; 122(1): 79–85.
Gal O, Rotshtein M, Feldman D, Mari A, Hallak M, Kopelman Y. Estimation of Gastric Volume Before Anesthesia in Term-Pregnant Women Undergoing Elective Cesarean Section, Compared With Non-pregnant or First-Trimester Women Undergoing Minor Gynecological Surgical Procedures. Clin Med Insights Women Health. 2019; 12.
Riveros-Perez E, Davoud S, Sanchez MG, Montesinos H, Rocuts A. Ultrasound your NPO: Effect of body mass index on gastric volume in term pregnant women – Retrospective case series. Ann Med Surg. 2019; 48: 95–8.
Copyright (c) 2025 Nikila Devarayasamudram Gopal, Rajkumaran Kamaraj, Reshma Ponnusamy, Lakshmi Ramakrishnan, Mouriya Subramani
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Indonesian Journal of Anesthesiology and Reanimation (IJAR) licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. Copyright holder is the author.
2. The journal allows the author to share (copy and redistribute) and adapt (remix, transform, and build) upon the works under license without restrictions.
3. The journal allows the author to retain publishing rights without restrictions.
4. The changed works must be available under the same, similar, or compatible license as the original.
5. The journal is not responsible for copyright violations against the requirement as mentioned above.
