A small portion (only 1% to 2%) of pregnant women will need non-obstetric surgery during pregnancy (that is, surgery that is not related to the pregnancy). If you are one of these women, you may be wondering if it’s safe for you and your baby. Depending on the type of surgery and why you need it, there are many risks and benefits to consider with your healthcare provider so you can make an informed choice about having surgery at the time that is right for you and your baby.
Surgery requires balancing the needs of two patients (mother and baby—more in the case of a multiple pregnancy!), and physical and hormonal changes related to pregnancy may require modifications to anesthesia use or surgical technique, but no woman should ever be denied medically necessary surgery because she is pregnant. Elective (non-necessary or non-urgent) surgeries, such as cosmetic procedures, however, should be postponed until after delivery.
The most common reasons that women undergo surgery during pregnancy include appendicitis, cholecystitis (gallbladder inflammation), pancreatitis (inflammation of the pancreas), trauma, and malignancy. The risk of needing surgery during pregnancy may be related to having a multiple pregnancy, smoking, how many pregnancies you have had, increased age of the mother, and increased body mass index.
Approximately 42% of women require surgery during the first trimester, 35% during the second, and 23% during the third. Surgery during the first trimester is the riskiest for the fetus due to the rapid growth of fetal organs. So, if it’s possible to wait until at least the second trimester, that’s the safest choice. The second trimester is a fairly safe time for surgery: the risk of miscarriage and preterm delivery are low, but the uterus is not too big yet, so abdominal surgery may be easier to perform than later in the pregnancy. There is a small risk of inducing preterm labor during surgery in the third trimester, but the risk is minimal and, depending on the exact gestational age of the fetus, the baby may still be healthy and viable. Third-trimester surgeries may be complicated simply because of the size of the uterus. Abdominal surgeries are particularly challenging during this time.
The American College of Obstetricians and Gynecologist (ACOG) has published guidelines to help inform pregnant women and other medical professionals about surgery during pregnancy. Importantly, ACOG states that sedatives and anesthetic agents used during surgery have not been shown to cause harm to developing fetuses. If it is possible, regional or local anesthesia is preferred over general anesthesia during pregnancy, just to reduce the chance of any risks related to medications used for anesthesia.
Non-obstetric surgery will likely be performed by a surgeon who is not an obstetrician. Therefore, it is important that the non-obstetrician communicate with your obstetrician when planning the surgery. Additionally, if possible, the surgery should be performed at an institution that has fetal and neonatal services and an obstetrician should be readily available if an emergent situation arises that affects the fetus. Depending on the type and length of surgery and the gestational age of the fetus, the surgeon and obstetrical team may choose to monitor fetal heart rate and contractions throughout the entire procedure.
Pregnancy testing should be conducted pre-operatively for all women of child-bearing age (in case a woman doesn’t know she is pregnant), but, as long as the mother’s overall risks related to surgery (for example, risks of low blood pressure or low levels of oxygen) are normal, there is no increased risk of surgery owing to the pregnancy during any trimester. All pregnant women undergoing surgery should be screened for a risk of blood clots and appropriate measures should be taken to prevent clots from forming.
If you are considering surgery during pregnancy, make sure you ask plenty of questions:
Is this procedure absolutely necessary?
Can this condition be treated without surgery?
What are the risks of NOT having the surgery?
Can the surgery be delayed until later in the pregnancy or until after the baby is born?
How will the surgery impact the baby?
Who will perform the surgery?
What will my recovery be like and how will it affect the baby?
Current knowledge suggests that historical concerns and refusals to perform surgery during pregnancy have no scientific basis and may actually lead to harm by preventing needed medical care.
Still, non-obstetric surgery during pregnancy is a legitimate concern for women and their physicians. But, take care knowing that mothers and babies can stay safe during procedures as long as all the care providers involved communicate and plan for emergencies that may arise. Overall, pregnant women and their babies have good outcomes after surgery and the recovery and post-operative care are routine in most cases.