What happens if you need to have surgery, but you’re pregnant? What are the risks?
A sudden need to undergo surgery can happen to anyone at any time. What we are talking about here are urgent non-obstetrical surgeries, which are procedures that don’t have anything to do with your pregnancy. An appendectomy, the surgery done to remove an infected or burst appendix, is non-obstetrical and urgent, as would be surgery to fix a broken ankle from an accident.
A cesarean section is surgery that is obstetrical in nature since it is only done on pregnant women.
Surgery that can be scheduled in advance and that does not involve a medical emergency is elective surgery. While elective surgery may be needed for health and safety, it does not need to be done immediately and can be postponed. An example of elective surgery would be surgery to repair a hernia.
There are always some risks to having a surgical procedure. But your pregnancy complicates things. Your baby is along for the ride during your surgery, which means that there are risks for two people, or more if you are having more than one baby.
With most types of surgery, your surgeon—with the advice of your obstetrician—will try to delay the surgery until a few weeks after you give birth. But in an emergency, delaying the surgery may not always be possible.
In an emergency surgery during pregnancy is necessary to either save the mother’s life or prevent further serious complications. The procedure cannot be put off until after the baby is born because the mother’s life or health is in danger. The benefits of the procedure outweigh the risks and there may be serious risks to not having the surgery. For example, an infected appendix may burst, which means that the infection could spread through the abdominal cavity and become life-threatening unless an appendectomy is done.
Still, your doctors will try to delay the surgery for as long as possible. In some situations, medications may be able to hold off the need for surgery. For example, medications can help alleviate an inflamed gallbladder until a few weeks after the baby is delivered, at which time the gallbladder can be removed.
Only about 2% of women will need urgent surgery during their pregnancy. The leading reasons for needing surgery include appendicitis, inflammation of the gallbladder, inflammation of the pancreas, intestinal obstruction, or due to trauma from an accident.
The American College of Obstetricians and Gynecologists (ACOG) says that surgery can be performed safely on pregnant women. ACOG states that there is no evidence that anesthesia or sedative drugs used during surgery have any effect on the baby when used in the standard dosages and there is no evidence from animal studies that there is any effect from limited exposure to anesthetics or sedatives. However, large clinical trials have never been done on pregnant women and the drugs used during surgery.
Any risks to the baby from surgery are greatest during the first trimester. This is when the major organs of the baby are being formed. When possible, urgent surgery should be delayed until the second trimester.
The second trimester—the middle of your pregnancy—is considered the safest time for surgery if it cannot be delayed until after childbirth. The risk of inducing a miscarriage is lowest at this time.
In the third trimester, there is an increased risk that the stress of surgery could bring on early labor. Another factor is that your uterus is large and heavy at this time. Most surgeries are performed with the patient lying on their back. In this position, the uterus puts pressure on the major blood vessels in the abdomen, the aorta and vena cava. Your surgeon may position you differently to avoid this problem.
Although anesthesia and sedation are considered safe, some surgeons will choose to use a regional or local anesthesia during the procedure rather than general anesthesia. Regional anesthesia blocks pain in a part of the body. In general anesthesia, you are completely asleep. Regional anesthesia is the type used during cesarean sections and anesthesiologists have a lot of experience with this type.
A specific risk for surgery during pregnancy is that there can be issues with blood clots during surgery. A pregnant woman’s blood clots more easily than usual. But it also means that a blood clot could form in the lungs or legs and cause problems. Blood clots could form in the weeks following the surgery, as well.
ACOG strongly recommends that the surgeon doing the procedure should consult with your obstetrician whenever possible. Fetal monitoring can be used to help keep track of the baby’s health during the procedure. If the baby goes into distress, there is the possibility that he or she may need to be delivered early.
If you need emergency surgery during your pregnancy, you may need to be moved to a hospital or medical center that has a neonatal and pediatric unit.
If you are pregnant and are told you need urgent surgery, make sure to contact your obstetrician or midwife immediately. Ask questions about why the surgery is needed and why it cannot be delayed. Ask both the surgeon and your obstetrician or midwife what the risks of the surgery are to you and to your baby and what the risks of not having the surgery are.