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Objectives To determine the prevalence and risk factors for full stomachs as assessed by gastric ultrasound in patients scheduled for elective caesarean section (CS).Design Case-control study.Setting One tertiary general hospital in Beijing.Participants A total of 140 non-labouring singleton pregnant women scheduled for elective CS between March 2024 and November 2024 at Peking University International Hospital were enrolled in this study. The inclusion criteria were as follows: ≥18 years of age, ≥37 weeks of gestational age, an American Society of Anesthesiologists physical status of II to III, and the ability to understand the rationale of the study assessments. The exclusion criteria included multiple pregnancy, obstetric urgency, an antenatal history of upper gastrointestinal surgery or upper gastrointestinal tract disease, the use of medications that may influence gastrointestinal motility and refusal to participate in the study.Interventions Based on quantitative and qualitative ultrasound assessments of the gastric antrum, patients were divided into two groups: a full stomach group (defined by a Perlas A score of grade 2 or the presence of solid contents or a gastric volume (GV)/weight >1.5 mL/kg) and an empty stomach group (defined by a Perlas A score <grade 2 and a GV/weight ≤1.5 mL/kg).Primary and secondary outcome measures The prevalence and risk factors for full stomachs in patients scheduled for elective CS.Results A total of 134 parturients were analysed. Overall, 48 parturients (35.8%) were identified as having a full stomach despite adherence to standard fasting rules for elective CS. According to multifactorial logistic regression analysis, gastro-esophageal reflux disease (GERD) during pregnancy (adjusted OR: 3.90; 95% CI 1.15 to 13.23; p=0.029) was identified as an independent risk factor for full stomachs in patients scheduled for elective CS.Conclusions In this study, we found that GERD during pregnancy is an independent risk factor for full stomachs as assessed by gastric ultrasound in patients scheduled for elective CS. Our results suggest that if a parturient has GERD during pregnancy, it would be desirable to perform gastric ultrasound to evaluate gastric emptying status prior to anaesthesia.Trial registration Chinese Clinical Trials Registry at http://www.chictr.org.cn (ChiCTR2400082033).