The ACOG (American Congress of Obstetricians and Gynecologists) recognizes the fact that non-obstetric surgery during pregnancy is an issue medical professionals deal with on a daily basis. Before any non-obstetric surgery takes place, the ACOG suggests a consultation between the surgeon and obstetrician to ensure maternal-fetal health is protected during the procedure. If no prenatal care has been established or an alternative caregiver (midwife) is being used in place of an obstetrician, the surgeon may wish to call in an obstetrician for consultation before surgery.
Risks of Surgery to the Pregnancy
The risks of surgery for the pregnant woman are similar to those associated with surgery regardless of pregnancy. Infection, blood loss and death are among the most dangerous potential surgical side effects. Pregnancy-specific risks include fetal loss or preterm delivery.
Large-scale clinical trials have not been completed regarding the possible impact of non-obstetric surgery on pregnancy due to the relatively small number of pregnant women who undergo surgery. The lack of clinical trials means doctors have no specific recommendations to guide the surgical planning. Though no specific recommendations exist, the ACOG does suggest:
- Elective procedures requiring surgery should be postponed until after birth.
- Necessary surgical intervention should not be postponed at any stage of pregnancy.
- If possible, postpone surgery until the 2nd trimester to minimize risk of spontaneous abortion.
- An obstetrician should be present in the operating room during the procedure to monitor maternal-fetal health.
- Surgery should be performed at a hospital with pediatric services and a neonatal unit.
- An obstetrician with C-section training and hospital privileges should be notified of the surgery in case emergency C-section delivery is required.
- Monitor previable fetal heart rate with Doppler before and after surgery.
- Monitor viable fetal heart rate throughout surgery with a continuous fetal heart rate monitor.
- Monitor contractions throughout surgery if the fetus is viable.
Who Should be Involved in the Surgical Planning Team?
When establishing a surgical team for non-obstetric surgery during pregnancy, the primary care surgeon should include the anesthesiologist, primary-care obstetrician, hospital obstetrician (if primary-care does not have hospital privileges) and pediatric/neonatal staff. The idea is to correlate a plan of action should surgery have an unexpected effect on the pregnancy or fetus. The team should be prepared to deliver a viable fetus should such delivery be required during surgery. If surgery is medically necessary and no neonatal or pediatric department is available at the attending hospital, air travel to the nearest emergency facility should be immediately available upon request.