The decision to have surgery while pregnant can be a difficult one. There are two patients to consider (or even more if the woman is pregnant with multiples) rather than one, and the risks of the procedure are greater than when the patient is not pregnant.
Elective procedures, such as plastic surgery, are not performed during pregnancy. In most cases, surgery during pregnancy is avoided whenever possible, to minimize complications for both the fetus and the mother. In most cases, if there is a decision to perform surgery on a pregnant woman it is because the life of the mother is in peril without surgery. For example, if the mother develops appendicitis the surgery will be performed as the risks of a ruptured appendix outweigh the risks of an appendectomy.
The human fetus is most susceptible to harm caused by exposure to medications during the first trimester, specifically during the first eight weeks of pregnancy. Surgery is avoided whenever possible during this time frame, and may be postponed until the second trimester when appropriate.
Why Is Surgery Avoided During Pregnancy?
There are multiple reasons why surgery is avoided during pregnancy. The pregnant woman is hypercoagulable, meaning her blood is more likely to clot than is typical outside of pregnancy. This change in clotting helps prevent a woman from bleeding too much during the delivery, but quintuples the risk of experiencing a blood clot during or after surgery.
For women who are 20 weeks or more into their pregnancy, a complication called aortocaval and venocaval compression can also be an issue. This happens when a woman is positioned lying on her back and the weight of the fetus restricts blood flow through major blood vessels. To avoid this, alternative positions that keep the patient from being flat on her back are used when possible.
In addition, when general anesthesia is given to a pregnant woman, the fetus also receives the anesthesia. For this reason, when appropriate, regional or local anesthesia is used instead of general anesthesia.
What About C-Sections?
A C-section (Cesarian section) is commonly performed on pregnant women, and is considered safe for both the mother and fetus; however, surgeries other than the C-Section are typically scheduled for 6-8 weeks after delivery. One exception to this standard is the tubal ligation procedure, which may be combined with a C-Section delivery.
More To Consider Before Having Surgery
Before having surgery while pregnant, there are multiple things to consider, including the following:
- Is the surgery absolutely necessary?
- What are the risks of not having surgery?
- Will the mother survive without surgery?
- Will the baby survive without surgery?
- Will the baby survive the procedure?
- Do the risks of the procedure outweigh the rewards of the procedure?
- Can the surgery be delayed until after childbirth without harming the mother or the fetus?
- Can the risks of anesthesia be decreased by having a regional anesthesia instead of general anesthesia?
- Can medications before, during and after the procedure be minimized to decrease risk?
- Can surgery be delayed until the second trimester begins to minimize risk to the fetus?
Preventing Surgery While Pregnant
There is always a risk that a woman of childbearing age may be pregnant when undergoing surgery. If you are having surgery and you are sexually active, it is important to have a pregnancy test prior to surgery. In most facilities, a pregnancy test is part of routine testing before a procedure; however, you can request a pregnancy test be done if it is not a standard part of patient care.
Anaesthesia for non-obstetric surgery during pregnancy. Continuing Education in Anaesthesia, Critical Care and Pain. Accessed May 2013. http://ceaccp.oxfordjournals.org/content/6/2/83.full