Is surgery during pregnancy safe? What moms-to-be should know

When medical emergencies happen, pregnant women might be surprised to learn that many non-obstetric surgeries, or procedures not related to pregnancy, often are safe with some basic precautions. For example, what if a pregnant mom develops appendicitis? A ruptured appendix is potentially life-threatening and should be removed.

Thankfully, only one to two percent of women require non-obstetric surgery during pregnancy.  When it is necessary, the most common reasons include:

● Appendicitis

● Cholecystitis (inflammation of the gallbladder)

● Pancreatitis

● Bowel obstruction

● Trauma surgery after an accident 

If a surgery for a pregnant mom can be postponed, such as a cosmetic procedure, it’s usually the best choice to wait until the baby is born. But some situations are tricky. For example, if an Ob/Gyn finds a suspicious mass in a pregnant woman’s ovary, it might not be an emergency, but it also shouldn’t be put off for too long.

The American College of Obstetrics and Gynecologists (ACOG) has recommendations to guide decisions about surgery during pregnancy, including:

● Non-urgent, elective surgery should be postponed until after delivery

● If possible, and without delaying care of the mother, non-emergency surgery should be performed in the second trimester, when preterm contractions, preterm delivery, and miscarriage are least likely

● A pregnant woman should never be denied surgery that she needs, regardless of trimester

The good news is that in the vast majority of cases when surgery during pregnancy can’t be avoided, moms and their babies tend to have good outcomes. That said, moms-to-be should know guidelines about surgery based on how far along a pregnancy is and what questions to ask if they do need surgery during pregnancy.

What’s safe and when? Non-obstetric surgery by trimester

First trimester  

We avoid surgery in the first trimester when we can because there are some risks related to anesthesia and other drugs when administered during the period of embryo genesis, which is when you baby is being formed. If the surgery is necessary but non-urgent it is best to delay it to the second trimester.  

Second trimester  

This is generally the safest time for pregnant women to have surgeries that can’t be postponed to after delivery. The risk of miscarriage or preterm delivery is lowest in the second trimester, and the uterus is not as big as it will become during the third, which makes abdominal procedures easier for the surgeon to perform.

Third trimester  

Because the uterus expands in the third trimester to accommodate the growing baby, there are special considerations for abdominal surgeries, such as appendectomies, during this trimester. The farther along a woman is in her pregnancy, the more technically challenging the surgery might be, and the surgeon might have to adjust their usual technique – for example, from laparoscopy to open incision. There also is a very small risk in this period that preterm labor will start during or after the surgery.

What questions should pregnant women ask about surgery?

Ob/Gyns collaborate with surgical and anesthetic teams to minimize risks to pregnant women and their babies. We encourage patients and their partners to ask questions and voice their concerns. Below are some of the questions women commonly ask about non-obstetric surgery during pregnancy.

Are imaging studies and X-rays safe?

If imaging studies are needed before surgery, we try to use ultrasound or magnetic resonance imaging (MRI) to avoid radiation. If an X-ray or computed tomography scan (CT scan) is necessary, we will minimize the amount of exposure to the baby.        

How safe are anesthesia and sedation medications?

Research shows that anesthetic medications generally used for surgery are safe for the baby ‒  there is no increase in birth defects. The sedation leaves the baby’s system just as it leaves the woman’s after surgery, so there is no lasting impact. 

Who will perform the surgery?

The specialist for the woman’s particular surgical problem will perform the surgery. For example, a general surgeon will remove a gallbladder, whereas a neurosurgeon will repair a brain aneurysm. When possible, an Ob/Gyn can help guide the surgeon with positioning the pregnant woman to:

● Access the surgery site more easily

● Maximize blood flow to the uterus

● Minimize disturbance of the uterus and baby

When the baby is viable, it’s also best to include an Ob/Gyn doctor and a pediatric doctor to monitor the pregnant woman and baby during surgery. If the procedure takes place during the second trimester, we will check the baby’s heart rate before and after the surgery. In a third trimester surgery, we might also monitor the heart during the operation or increase monitoring before and after, as well as observe the mother for contractions.

What if my dentist or ear, nose, and throat doctor (ENT) suggests surgery during my pregnancy?

Dental and ENT procedures done in outpatient settings are generally safe during pregnancy. We always recommend that pregnant women ask a non-obstetrical specialty doctor who is recommending a procedure to consult with the patient’s Ob/Gyn. 

What can I expect after surgery?

In general, pregnant women can expect a recovery that is routine for the procedure, just as if she weren’t expecting a baby. If at any time something doesn’t feel right after surgery, it’s important to call a nurse or Ob/Gyn right away.

To learn more about guidelines for non-obstetric surgery for pregnant women, call at 214-645-8300 or request an appointment online.