| PurposeTo evaluate gastric contents before elective cesarean section in pregnant women with gestational diabetes mellitus by bedside ultrasound,to explore the effect of gestational diabetes mellitus on the risk of perioperative reflux and aspiration in women,and to analyze the related factors affecting the gastric volume of pregnant women with diabetes.MethodsThis study is a prospective cohort study.Approved by the ethics committee of the affiliated Provincial Hospital of Shandong University,informed consent was signed by the patients and their families.The full-term pregnant women with gestational diabetes mellitus(GDM group)and full-term pregnant women with normal glucose tolerance(control group)who underwent elective cesarean section in our hospital from January to December 2021 were selected as the research subjects.All research subjects fasted solid food for at least 8 hours and water for at least 2 hours before the ultrasound examination.The antrum of the puerpera was examined by bedside ultrasound before anesthesia,and the standardized antrum of the puerpera was obtained in the semi-recumbent position with head height of 45° and in the right lateral position.The gastric contents were qualitatively assessed and then semi-quantitatively graded.The gastric antrum cross-sectional area(CSA)was measured by tracing method,and the predictive value of gastric volume was calculated by a mathematical model.Maternal reflux aspiration risk was divided into low risk,medium risk and high risk according to the qualitative,semi-quantitative grading of their gastric contents and gastric volume.Both groups of women were given spinal anesthesia.The semi-quantitative grading of gastric contents,CSA in both positions,gastric volume and gastric volume per weight,and the risk of reflux and aspiration assessed by ultrasound were compared between the two groups.Fasting blood glucose was measured before ultrasound examination,and glycosylated albumin level was recorded within 24 hours before surgery.The incidences of nausea,vomiting and reflux and aspiration were recorded in the two groups of puerpera.Pearson correlation analysis was used to test the related factors affecting the gastric volume of the two groups of puerpera.ResultsA total of 201 subjects were included in the study,including 101 cases in GDM group and 102 cases in control group.There was no significant difference in semi-quantitative grading,semi-recumbent CSA,right lateral CSA,gastric volume,gastric volume per weight in the two groups of maternal gastric ultrasonography(P>0.05).There was no significant difference in the composition ratio of the risk of reflux and aspiration between the two groups of puerpera assessed by ultrasound(P>0.05).Compared with the control group,the relative risk(RR)of high risk of reflux and aspiration in GDM group was 3.465.95%confidence interval(CI)was 0.843～14.460.The RR of medium and high risk of reflux and aspiration was 1.142.95%CI was 0.825～1.590 with no statistically significant difference.In GDM group,2 puerpera developed vomiting,and no obvious aspiration occurred during the operation in all puerpera.The gastric volume of the two groups of puerperium was significantly positively correlated with body weight and body mass index(BMI)(r>0,P<0.05),and was no statistical correlation between the gastric volume,height,gestational age,fasting solid food time,fasting water time,fasting blood glucose level,and glycated albumin level of the two groups(P>0.05).Conclusions1.There were no differences in gastric contents and reflux and aspiration risk in fasting state between puerpera with gestational diabetes and normal glucose tolerance.2.The gastric volume of puerpera with gestational diabetes mellitus is positively correlated with body weight and BMI. |
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