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Nonobstetric Surgery During Pregnancy

Tolcher, Mary Catherine, MD, MSc; Fisher, William E., MD; Clark, Steven L., MD

doi: 10.1097/AOG.0000000000002748
Medical Complications of Pregnancy: Clinical Expert Series: PDF Only

One percent to 2% of pregnant women undergo nonobstetric surgery during pregnancy. Historically, there has been a reluctance to operate on pregnant women based on concerns for teratogenesis, pregnancy loss, or preterm birth. However, a careful review of published data suggests four major flaws affecting much of the available literature. Many studies contain outcomes data from past years in which diagnostic testing, surgical technique, and perioperative maternal–fetal care were so different from current experience as to make these data of limited utility today. This issue is further compounded by a tendency to combine experience from vastly disparate types of surgery into a single report. In addition, reports in nonobstetric journals often focus on maternal outcomes and contain insufficient detail regarding perinatal outcomes to allow distinction between complications associated with surgical disease and those attributable to surgery itself. Finally, most series are either uncontrolled or use the general population of pregnant women as controls rather than women with surgical disease who are managed nonsurgically. Consideration of these factors as well as our own extensive experience suggests that when the risks of maternal hypotension or hypoxia are minimal, or can be adequately mitigated, indicated surgery during any trimester does not appear to subject either the mother or fetus to risks significantly beyond those associated with the disease itself or the complications of surgery in nonpregnant individuals. In some cases, reluctance to operate during pregnancy becomes a self-fulfilling prophecy in which delay in surgery contributes to adverse perinatal outcomes traditionally attributed to surgery itself.

Most traditional concerns regarding risks of surgery during pregnancy have no scientific basis and may lead to maternal and neonatal harm.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, and the Department of Surgery, Baylor College of Medicine, Houston, Texas.

Corresponding author: Steven L. Clark, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, 6651 Main Street, 10th Floor Houston, TX 77030; email: steven.clark@bcm.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Continuing medical education for this article is available at http://links.lww.com/AOG/B121.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received December 04, 2017

Received in revised form January 23, 2018

Accepted March 23, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.