Pregnancy and Surgery: What You Need To Know

The decision to have surgery while pregnant can be a difficult one and is often made out of necessity rather than desire. There are two patients to consider (or even more if the person is pregnant with multiples). In general, surgical risks are greater when a patient is pregnant because of the changes that take place in the body during that time.

There are some cases when surgery can be avoided if a patient is pregnant, but this is not always the case. In fact, certain surgeries (such as a C-section) are often part of pregnancy. Here's what you need to know about surgery and pregnancy.

Surgery During Pregnancy

In most cases, surgery during pregnancy is avoided whenever possible. This is done both to minimize complications for the pregnant person and the fetus. When a decision is made to perform surgery on a pregnant person, it is typically because their life is in danger.

For example, if a pregnant person develops appendicitis, surgery will be performed to remove the infected organ because the risks of a ruptured appendix outweigh the risks of having an appendectomy. 

By contrast, a rhinoplasty (nose job) would not be performed. Elective procedures, such as plastic surgery, are not performed during pregnancy.

Certain procedures may or may not be performed. For example, a procedure to remove a painful, inflamed gallbladder might be performed, depending on the severity of the condition and the general health of the pregnant person and the fetus.

A human fetus is most susceptible to harm caused by exposure to medications during the first trimester—specifically, the first eight weeks of pregnancy. Surgery during this time is usually avoided. If it must be done, surgeons will try to postpone a procedure until the second trimester to reduce the risks.

Why Its Avoided

There are multiple reasons why surgery is avoided during pregnancy. One reason is that a pregnant person is hypercoagulable—a medical term meaning their blood is more likely to clot than is typical outside of pregnancy. This change in clotting helps prevent a pregnant person from bleeding too much during childbirth. However, it quintuples the risk of experiencing a blood clot during or after surgery.

For a pregnant person who is 20 weeks or more into their pregnancy, a complication called aortocaval and venocaval compression can also be an issue. This happens when a pregnant person is positioned lying on their back and the weight of the fetus restricts blood flow through major blood vessels. To avoid this, alternative positions that keep a pregnant patient from being flat on their back are used when possible.

In addition, when general anesthesia is given to a pregnant person, the fetus also receives the anesthesia. Regional or local anesthesia is used instead of general anesthesia when possible.

C-Sections

A C-section (Caesarean section) is commonly performed on a pregnant person and is considered safe for both the patient and fetus. However, surgeries other than the C-section are typically scheduled for 6 to 8 weeks after delivery.

One exception is a tubal ligation procedure. According to the American College of Obstetricians and Gynecologists (ACOG), this form of postpartum sterilization can be performed as soon as a few hours to days after delivery.

Considerations

Before having surgery while pregnant, there are multiple things to consider. Here are some questions that medical professionals and patients can ask to clarify the risks of performing a surgical procedure on a person who is pregnant.

• Can medications before, during, and after the procedure be minimized to decrease risk?
• Can surgery be delayed until the second trimester to minimize risk to the fetus?
• Can the risks of anesthesia be decreased by having local anesthesia instead of general anesthesia?
• Can the surgery be delayed until after childbirth without harming the pregnant patient or the fetus?
• Do the risks of the procedure outweigh the rewards of the procedure?
• Is the surgery absolutely necessary?
• What are the risks of not having surgery?
• Will the baby survive the procedure?
• Will the baby survive without surgery?
• Will the pregnant patient survive without surgery?

Prevention

There is always a risk that a woman of childbearing age might be pregnant when undergoing surgery. If you are you are sexually active and need to have surgery, you will need to have a pregnancy test before the procedure.

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 pre-op patient care.

A Word From Verywell

It is always advisable to avoid surgery during pregnancy when possible, but many procedures performed on people who are pregnant are successful. 

Surgery during pregnancy is not an ideal situation, as it typically means that a person who is pregnant is experiencing a serious, even life-threatening, health issue. That said, if the right precautions are taken it is possible to have a good surgical outcome for both a pregnant patient and a fetus.