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Management of the pregnant patient undergoing nonobstetric surgery

Authors
Errol R Norwitz, MD, PhD, MBA
Joong Shin Park, MD, PhD
Denis Snegovskikh, MD
Section Editors
David L Hepner, MD
Charles J Lockwood, MD, MHCM
Deputy Editors
Marianna Crowley, MD
Kristen Eckler, MD, FACOG

INTRODUCTION

Surgical procedures unrelated to pregnancy are sometimes necessary; for example, in a series of 720,000 pregnant women, there were 5405 nonobstetric operations, for an incidence of 0.75 percent [1]. The most common operations during pregnancy are appendectomy and cholecystectomy, but almost every type of surgical procedure has been performed.

Whenever a pregnant woman undergoes nonobstetric surgery, consultations among her obstetrical team, surgeon(s), anesthesiologist(s), and neonatologist(s) are important to coordinate management [2]. Anatomic and physiologic changes related to pregnancy and concerns about the fetus may require modifications to anesthetic and surgical management.

There are no randomized trials evaluating management of nonobstetric surgery in pregnant patients. The following discussion is based upon data from observational studies, expert opinion, and extrapolation from trials during cesarean delivery.

COMMON INDICATIONS

The most common nonobstetric conditions requiring surgery during pregnancy are appendicitis, biliary disease, ovarian disorders (torsion, neoplasm), trauma, breast or cervical disease, and bowel obstruction (table 1). Surgical management of specific disorders in pregnant women is discussed in detail in individual topic reviews for each disorder.

PHYSIOLOGICAL CHANGES RELATED TO PREGNANCY

Physiological changes related to pregnancy occur in virtually all systems and are caused by both hormonal and mechanical factors. Pertinent changes in major organ systems are summarized below; in-depth reviews of each topic can be found separately:

                                            

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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 21 00:00:00 GMT+00:00 2016.
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References
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