Non-Obstetric Surgery During Pregnancy

Posted On: January 18, 2017 By Nathan D. Fox, MD

There are many concerns of surgery during pregnancy. Some of these concerns include damage to the fetus from medications used for anesthesia or pain control, pregnancy loss, increased bleeding, infection, and preterm labor. These risks are in addition to the inherent risks of the operation itself.

For obvious reasons, there are no randomized data on surgery during pregnancy and the knowledge of risks are solely based on retrospective and observational case series, making it difficult to distinguish whether any negative outcomes seen were caused by the operation or the condition that lead to the necessary operation.  Meaning, if someone is 12 weeks pregnant and miscarries after an emergency appendectomy, it is hard to know if it was due to the operation or the appendicitis, and it is very difficult to design a study to answer that question.

For elective surgery, it’s recommended to delay until after pregnancy. Operations that are needed, but not an emergency are preferentially performed in the second trimester, as the baby is already formed (low risk of anything causing a birth defect, and before the time when women might have preterm labor). Emergency and life-saving operations are never delayed due to pregnancy.

Pregnant Women & Surgery Considerations

Here are some considerations when a pregnant woman requires an operation:

  • The anesthesiologist should be informed that the patient is pregnant before the procedure. This information is vital to modify planned anesthesia due to the altered anatomy and physiology during pregnancy, including the risk of aspiration, mild respiratory alkalosis, and decreased functional residual capacity.
  • If the patient is at a higher risk for pre-term delivery, antenatal corticosteroids should be considered.
  • Thromboprophylaxis (prevention of blood clots) requirements may be altered due to the relative hypercoagulable state during pregnancy.
  • In the third trimester, positioning during pregnancy should ideally not be supine (flat on back) in, due to the enlarged uterus compressing the maternal great vessels.

Fetal Monitoring

Since there is a possibility of uterine hypoperfusion and possible fetal hypoxemia/acidemia during the third trimester, fetal monitoring before, during and after surgery is a recommended option for pregnant women undergoing surgery. The American Congress of Obstetricians and Gynecologists (ACOG) is vague about who requires intraoperative continuous monitoring. If it is decided, the following conditions should be present: fetus is viable, monitoring is physically possible to perform, someone is available to intervene, and there is informed consent for cesarean delivery in an emergency. If indicated, an interruption of the planned procedure for a cesarean delivery can be performed safely.  For more information visit our blog or contact Carnegie Imaging.

Carnegie Imaging for Women blogs are intended for educational purposes only and do not replace certified professional care. Medical conditions vary and change frequently. Please ask your doctor any questions you may have regarding your condition to receive a proper diagnosis or risk analysis. Thank you!

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