What if You Need Anesthesia and Surgery While Pregnant?

Surgery During Pregnancy Is a Last Resort

Only very necessary surgery is performed on pregnant women. As expected, there are risks to both the mother and fetus from the stress of surgery and anesthesia, and from the direct effects of both. Before deciding to operate on a pregnant woman, it must be clear that the risks of NOT operating must outweigh the risks of doing so.

As a physician anesthesiologist, I know that there will need to be a team approach and discussion about the risks and benefits of how and when to do the surgery. We take this approach each time to keep you and your baby as safe as possible if you need to have surgery while you are pregnant.

It is not a decision that is entered into lightly. If your surgeon or obstetrician says you need surgery, you probably do. If you aren't comfortable with their decision, you can ask for a second opinion, but this may not be practical in an urgent situation.

Here are the areas I will focus on related to surgery and pregnant women in this article:

• Most common surgeries performed
• Risks to pregnant mother during non-obstetric surgery
• Risks to the fetus during pregnancy
• Notes for the anesthesia team
• Official recommendations

Most Common Surgeries Performed

In the United States, about 80,000 surgeries are performed on pregnant women each year. This means that 1 to 2 percent of women will undergo surgery while pregnant.

As in the example, appendicitis is the most common reason for a woman to have surgery while pregnant. Appendectomy on a pregnant woman can be done by either a laparoscopic (camera and instruments placed through small incisions) or open (one incision in the right lower abdomen). Both techniques have advantages and disadvantages and you should discuss this with your surgeon as each case must be decided on its own specifications.

Gallbladder surgery usually can be delayed until after delivery with pain managed medically during pregnancy. Occasionally, the gallbladder is so inflamed, blocked by stones, or infected that it has to come out to prevent more serious illness. This is usually done laparoscopically.

Ovarian torsion (twisting) causes severe pain and puts the ovary at risk of "dying" by cutting off its blood supply. Ovarian cysts are also relatively common during pregnancy. Laparoscopic surgery is usually the method of choice for ovarian surgery when pregnant.

Cervical cerclage is done during pregnancy to prevent the cervix from dilating and leading to a resultant preterm delivery.

Trauma surgery usually follows a motor vehicle accident, although other accidents may also require surgery.

Breast and bowel surgery may also have to happen on an urgent or emergent basis.

Risks to Pregnant Mother During Non-Obstetric Surgery

There are traits of pregnancy that make anesthesia more risky. Changes in nearly every organ system occur due to hormonal and anatomic alterations. Anesthesiologists study these changes in detail and are prepared to provide anesthesia with the anatomy and physiology of the pregnant woman in mind.

Airway: Because pregnant women retain water, their soft tissue and mucosa around the airway (nose, mouth, throat) tend to "swell". This can make the placement of a breathing tube more difficult. Indeed, this is one of the most dreaded obstacles for anesthesiologists. Once asleep, there is limited time to place the breathing tube and resume oxygen delivery before mom and baby are at risk. Luckily, our training includes recognition of and planning for this situation.

Swelling of the tissues around and over the windpipe can also present danger after surgery. Oxygen levels and breathing are monitored closely in the recovery room to make sure this isn't an issue.

Also, blood supply is increased to the airway of pregnant women and the soft tissues are more sensitive and fragile. Bleeding of the mucosa (lining) of the mouth or throat can cause the above difficult airway, or it may lead to irritation of the vocal cords (causing them to spasm close after removal of the breathing tube, making oxygen delivery difficult).

Anesthetic Concerns: Your anesthesiologist is trained to know that the required amount of anesthesia is reduced by up to 40% during pregnancy. He or she will monitor you carefully to make sure you don't get too much—or too little— anesthesia.

Aspiration: By the 16th week of gestation, changes in the gastrointestinal system make heartburn and acid reflux very common. Even asymptomatic pregnant women are considered to be at risk. In the third trimester, the additional pressure placed on the stomach by the lower abdomen adds to the likelihood that acid could be pushed up from the stomach into the esophagus and all the way up to the throat where it can enter the windpipe and lungs.

Blood Pressure: A pregnant woman has a higher volume of fluid and blood circulating in her system. But, hormonal changes cause the blood vessels to relax a bit. The overall effect is lower blood pressure which may decrease even more under anesthesia. Because too-low blood pressure puts the baby at risk of not getting enough blood and oxygen, this is monitored and maintained very carefully by the anesthesiologist.

Breathing: While the breathing tube is in place (and it will be for general anesthesia), the ventilator can help you breathe. After surgery, you must take over this function again. Your oxygen reserves are reduced during pregnancy. Also, a large uterus can make it difficult to take deep breaths, especially while you are groggy. You will be monitored and reminded to do this regularly so your (and baby's) oxygen level doesn't drop.

Recovery: In the recovery period, your baby may be at risk of arriving early. This is especially true if you had to have surgery in the third trimester. The nurses in recovery (or on the OB unit) can monitor your uterine contractions and the baby's heart rate. Medications can be given if contractions start.

The risk of preterm delivery may persist for the rest of pregnancy. In addition, pregnant women are more prone to blood clots in their legs and lungs after surgery and should be encouraged to walk as their surgical and obstetric conditions allow.

Risks to Fetus During Pregnancy

Of course, all of the factors that cause complications in the mother also put the baby at risk. The biggest concerns for the baby are birth defects, miscarriage, and pre-term delivery.

Birth defects: There is no evidence that babies born to mothers who had surgery during pregnancy have a higher incidence of birth defects. Of course, designing a study where pregnant women are unnecessarily exposed to anesthesia and surgery, to establish this definitively is impossible to do (ethically). There is potentially some evidence that lower-birth weight may occur in these babies.

Miscarriage: Miscarriage occurs in 1 to 2 percent of women who have surgery during pregnancy. It is unclear whether this is precipitated by the illness, the surgical procedure/manipulation or the anesthesia, or a combination.

Pre-term labor: As above, it is unclear why the risk of preterm labor seems to be increased, but most studies show a small increased risk of preterm labor after surgery in pregnant women. Some researchers believe that anesthesia gases may relax the uterus and help prevent preterm labor, and therefore, recommend general anesthesia (as opposed to spinal or epidural).

Timing of Surgery

The second trimester is considered the best time to perform surgeries on pregnant women that are necessary but not emergent. Organ development in the first trimester means there is a (theoretical) risk of abnormal development. By the third trimester, the risk of preterm contractions and delivery is increased.

Notes About Anesthesia Team

Here are some things the anesthesia team considers when performing general anesthesia on a pregnant surgery patient:

• Obtain an obstetrics consult.
• Provide preop aspiration prophylaxis.
• Consider intraoperative, continuous fetal heart rate monitoring.
• Ensure left uterine displacement to maintain blood flow to the uterus and placenta, especially after 20 weeks of gestation.
• Preoxygenate fully.
• Perform a rapid sequence induction with difficult airway plans and equipment immediately available (ETT is mandatory after about 16 weeks).
• Use smaller endotracheal tubes.
• Consider prepping before induction to minimize anesthesia time.
• Maintain hemodynamics and CO2 carefully (obviously).
• Reassure the anxious patient that anesthesia during pregnancy is much safer than most people realize and problems are relatively rare.

Official Recommendations

The joint statement from the American Society of Anesthesiologists and the American College of Obstetrics and Gynecology boils down to a few key points.

1. Obtain an obstetrics consult.
2. No standard anesthetic agent is known to be teratogenic for a one-time exposure.
3. Urgent, but non-emergent surgery should be delayed until the 2nd trimester, when possible.
4. Monitor the fetus with continuous heart rate and contraction monitoring IF.

• the fetus is of viable gestational age (or positioning will be aided by monitoring),
• an obstetrician is available to intervene,
• the patient consents to emergency C-section delivery,
• and it is possible to do so;
• otherwise, check fetal heart tones and uterine contractions before and after surgery

Closing Thoughts

All in all, women tend to feel reassured after learning the facts about anesthesia and surgery during pregnancy. There is some risk, but it really tends to be lower than most people expect. Also, knowing that the doctors and nurses have faced this dilemma before helps the understandably anxious mother-to-be.

Feel free to leave comments or questions as I try to answer each one personally.

Related Reading

• First Trimester Pregnancy Pains: When to Call Your Doctor
  Pregnancy is a time of joy for most women, but it can also be filled with concern and anxiety over aches and pains. Whether it's lower back pain, hip pain, cramping, or something else, learn which pains are perfectly normal and which are more concern
• What Is Gestational Diabetes During Pregnancy?
  Learn about gestational diabetes in pregnancy, including symptoms, testing, and treatment. Included are resources for what to eat, how to exercise, and how to avoid gestational diabetes.
• Understanding Tubal Pregnancy and Ectopic hCG Levels
  Confused about tubal pregnancy? Not sure what to make of your hCG levels? Slow rising hCG levels may indicate an ectopic pregnancy. Normal pregnancies should demonstrate a hormone doubling time of 48-72 hours.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Comments

Mary on June 30, 2019:

Hi I am so grateful I found this article! Warms my heart and less anxious. I have Thyroid Carcinoma and I am 7 weeks pregnant. I am schedule for removal of my thyroid on my second trimester ( 16 weeks) . I am so scared and anxious about the surgery and the effects of anesthesia to my baby. Luckily I found this. Anyone who has the same situation? reply would mean so much. Than You!

Keo on August 30, 2018:

Hi I did a Mastopexy surgery,blood tests were taken but pregnancy on 29 May they didn't show couple of weeks after missed my periods didn't didn't read too much into it on 23 June I did a pregnancy test it showed positive so there I was thinking I'm still under 10 weeks preggis I went for a sonar 1s week August and it shows I'm 13 weeks and 6 days pregnant. My concern is they didn't pick it up so I don't know what dose of anaesthesia they used ,I was also given tramdol pills and antibiotics for 2 weeks or so ,going for a fetal assessment on the 10 September but I can't stop thinking whether or not there are any defects seeing that it was the 1st trimester. I don't know how it happened that the pregnancy wasn't picked up because I wasnt prepared Please advise thanks

Rhonda diaz on October 31, 2017:

I needed surgery on my hip and leg due to getting hit and ran by an suv 7 months pregnant being 21 years old i was scared for my life but god was there for us i had my baby full term and without inducement or epidural i had reconstructive surgery they placed a metal rod from my hip to my knee with 4 nails.. Im proud to say i was walking 4 days after surgery and after 2 months and a natural birth i switched from crutches to a cane and glad to also add im walking without any type of aid and my miracle baby is learning how to pull herself up..❤ i hope this story helped you in a way... Yes i did it and you can do anything you put your mind too as well

Juliana on October 16, 2017:

Hello! I am 23 weeks pregnant and need to have a mastectomy done on my right breast due to carcinoma in-situ (stage 0). I will be 24 weeks this Thursday and potentially surgery will take place before i turn 25 weeks. I am freaking out about the risks of pre-term labor as all i want is my baby to be safe... Any comments, help, guidance on this? Thank you!!

Jane on September 09, 2017:

I am 5 weeks pregnant and in need of surgery. I have a fibroid measuring 16 cm above my uterus and I am worried this fibroid will crush the baby as it moves up. When is the best time during pregnancy to have this done. I need it done really early. Can regional anesthesia be used?

Krystal on April 02, 2017:

I had to have a chat drained off my left ovary on Wednesday. They have me on Percocet post-op. Will this be harmful to my baby? I haven't taken the recommended 2 every 6 hours, but a half to a full one right before bedtime. Also, is it ok to still be icing the incisions? I am a new mommy and am nervous about everything. Thank you so much for any information!

Tavia on February 10, 2017:

I have to have a tracheal synopsis (I believe thats what the dr called it). He has to place a balloon down my throat to stretch it due to scar tissue from years ago. Today, I struggle to breathe just walking across the room. The time they have scheduled, I will be 30 weeks pregnant....I can't find any information on timing, etc. Can you provide any insight?

Thanks!

lilpatoot from Schenectady, NY on January 18, 2017:

I look back now and wonder how I did it. 36 years ago, I was 4 months pregnant with my son, Matt. I started with pain in the center of my belly. It began feelng like gas, but sped right into overdrive. They couldn't decide what to do, since the pain wasn't where it should have been. They opened me up as an exploratory to find an appendix ready to burst in their hand. Three weeks later while I was home recuperating, I started with sharp pains in my stomach. I was brought to the same floor and they were "watching" it for another day. I had an intestinal blockage from the adhesions that had formed from the initials surgery. It got to the point all that had been pumped into me abruptly changed course and exited out the front. The same thing happened to me three weeks later, resulting in a third surgery. The last straw came with a bowel obstruction. The doctor's advice at that point, since I was about 7 months along at this point, was to stay on a completely liquid diet. We just couldn't risk one more surgery , especially since I was scheduled for a C-section!! I found strength somehow.

Monae on September 01, 2015:

Hi, I have completely torn my ACL. I am 5 weeks pregnant and I am in the military. The military is not going to let me wait a year for me to have surgery and I am due to transfer soon. I am very nervous and I do not know what is the best choice for me. When I think about it, I am going to gain weight during this pregnancy and my knee is unstable. What should I do?

Kayla on June 08, 2015:

Thank you for taking the time to write this. Last week, at 10 weeks pregnant, I had emergency, exploratory surgery via laproscopy. They took me back to surgery so quickly, my family didn't even have time to arrive to the hospital. It ended up being appendicitis and I had fluid around my uterus, most likely due to my inflamed appendix. Now even knowing I needed the surgery and that the benefits outweighed the risks, I still feel guilty and petrified. I have heard the heartbeat twice since surgery. I have another appointment today and Friday where I am sure they will listen again, I am still scared. Your article made me feel much more relaxed about the whole situation. Thank you again from the bottom of my heart.

Steph on June 10, 2014:

I really appreciate this article - I'll be reading it over and over again in the upcoming days. I'm 24 weeks pregnant and just found out I have thyroid cancer. Two cancerous masses, one of which is pretty large and growing quickly. My endocrinologist wants me to do the surgery to remove my thyroid ASAP - before my third trimester begins. I'm, of course, very nervous about how my little one will do. This article was very reassuring that the effects of anesthesia aren't as bad as I think they are. I haven't met with the surgeon yet, so I'll have to wait and see if all doctors are on the same page for how to proceed.

It's hard to balance what is safest for mom AND safest for baby. This article has made me feel more confident that things will probably be OK with this surgery.

Thank you for taking the time to write this. :)

TahoeDoc (author) from Lake Tahoe, California on April 19, 2014:

Hi Venus-

This is a complicated problem, to be sure. BUT, your doctor really will have the best advice for you- you can certainly get a second opinion, but if they suspect a perforation, you don't want to risk rupture as the baby grows.

I am not an obstetrician so I'm not sure how much more risk there is to the uterus (and you and baby) if you wait till the second trimester, so you will have to go with your/specialist obstetrician's advice on this.

I'm not sure where you are located, but if possible, I would make sure you are getting these opinions and the surgery from experienced obstetricians- perhaps at a specialty maternity hospital or department that deals frequently with high-risk pregnancies and not a general obstetrician. I don't know if having to do an open surgery to repair the perf is normal (it may be due to the positioning of the uterus, I just don't know), but again, get the opinion from a reputable doctor and center- you can ask for a referral to a high-risk obstetrics practice if you aren't already at one. There are docs who specialize in high-risk pregnancy.

When you have your surgery, you will most likely have general anesthesia since it is laparoscopic surgery. Again, if you are at a center that does uterine surgery during pregnancy, they may have different protocols, but I doubt it.

Once they repair the perforation, it should be ok for the pregnancy. It may be one reason they'd want to do this sooner than later- the suture line will become stronger over time…Again, your doctors (specialists if possible) will be the best judges of this.

Good luck to you- I hope everything turns out great- I bet it will !!

Venus on April 16, 2014:

Hi, I am 7 weeks pregnant now and suspected to have perforation in my uterus that I might have acquired when I had my D & C a year ago. My doctor referred me to an OB/ Radiologist to have a 2nd opinion and she's not sure as well what's inside my uterus but she said the nearest case is uterine perforation. My doctor is suggesting to have a diagnostic laparoscopy to see how serious the damage is and confirm that it is really perforation, since I am at risk of uterine rupture. After the procedure and when the perforation is confirmed the doctor will do an open surgery to "stitch" the perforation.

After reading your article, i feel a little bit relieved but the I am still worried. I have consulted as well an OB friend way back in the Philippines, she said that just to follow my doctors advice since he has all my records, but seek for a 2nd opinion with a Filipino doctor a Sonologist one. She also advised to delay the Laparoscopy procedure until you reach the second trimester coz you'll be at risk of miscarriage.

I just need your opinion as a professional regarding what type of anesthesia is applied on laparoscopy and if ever i will undergo surgery what is the assurance that the stitches inside the uterus and the stitches on my abdomen, where the entry for the surgery takes place, will not collapse or open?

TahoeDoc (author) from Lake Tahoe, California on March 22, 2014:

Hi Rachel,

It does seem in your case that surgery cannot be delayed and any small risk will be well worth the mobility and recovered function while pregnant and caring for a newborn. It sounds like you will have a spinal or epidural for your surgery-those are great choices, but even if you have to have general anesthesia, it will likely be ok. I know this is scary and not ideal, but it is true that the risk of any issue is very, very low. You need to take care of your baby and if you are in your first trimester, better to get it done and heal now.

Good luck and I can't imagine how you must feel trying to process everything. Get well soon & congrats on the pregnancy!

Rachel on March 22, 2014:

I shattered my tibial plateau skiing and it's bad! I had surgery scheduled for Friday and found out as I was going into surgery that I am pregnant. My doctor sent me home and postponed my surgery until Monday so I could process the risks. It is not an option to not have surgery. I can't walk and will be unable to until I have surgery. If I wait, a total knee replacement will be my only option and at 30 that's highly unadvisable. Instead of general anesthesia, I will only be numb from the waist down. My understanding is that there is a less than 2% chance of an issue. Know if anyone else that's been in this situation? Carrying a baby for 9 months while not being able to walk or care for myself seems to be the bigger risk.

TahoeDoc (author) from Lake Tahoe, California on January 27, 2014:

Hi Brian,

Tonsillectomy and adenoidectomy are not considered essential surgeries. I would think they should wait until after the baby is born. While this is considered 'routine' surgery, there is still a significant risk of bleeding, especially in an adult who is pregnant. Pregnant women are known to have increased vasculature (blood supply) and bleeding after tonsil surgery is a life-threatening emergency that would compromise the life of the mother and baby.

If there are extenuating circumstances for why this would be considered during pregnancy, that is something to discuss with the head and neck surgeon, ob-gyn and anesthesiologist who agree to undertake this risk.

Brian on January 17, 2014:

What about getting your tonsils removed and adenoids or whatever their called ?

TahoeDoc (author) from Lake Tahoe, California on December 17, 2013:

Selina- I'm so sorry- some glitch is preventing comments from showing up in some of my hubs and I just saw your question from months ago.

If you happen to see this, which I highly doubt, please let me know what y our did and how you are doing.

sunita on December 16, 2013:

Good luck

Selina on May 17, 2013:

Thank you for the information. I am 11 weeks pregnant and have scheduled knee surgery at 14 weeks pregnant. My OBGYN says to go ahead, and my Orthopedic surgeon say it is fine. I have also spoke with about four other doctors, surgeons and OBs. I just received a call from the anesthesiologist who has scared me out of it. I am very torn, I can't imagine 7 more months of pain with this knee, then getting surgery once I have a new baby, but I also don't want to something selfish and endanger my child. What is your opinion? Should I go ahead and get my ACL fixed? I was planning on getting a spinal rather than being fully knocked out. Is this safer?

TahoeDoc (author) from Lake Tahoe, California on May 12, 2013:

Carrie- Thank you for letting me know this helped you. That is exactly why I wrote these articles so that is very satisfying for me. It can be so hard to get answers that are directed to patients.

Good luck with everything! And, congrats!

Carrie on May 12, 2013:

Thank-you so much for your article! I have looking for hours trying to find an answer where they talked in detail about this subject. I just found out I am pregnant and I am in desperate need of knee surgery that I am supposed to have later this month at Mayo. I will most likely postpone it now, even though it may put me on bed rest by 20 weeks. My knee is completely shot but my pregnancy is more important!

TahoeDoc (author) from Lake Tahoe, California on February 24, 2013:

Elective surgery is NOT recommended during pregnancy at all, and really not during early pregnancy. Please inform your OB/Gyn or Fertility doctor AND the orthopedic surgeon of your plans ASAP!

gonch on February 24, 2013:

I just got inseminated on Sat 2-23 and I will be needing meniscus surgery on 3-12. So if it takes and I am pregnant then I would be approximately 2weeks pregnant. Since it is so early would this damge my pregnancy?

TahoeDoc (author) from Lake Tahoe, California on May 30, 2012:

Good luck to you Heather!

Heather on May 30, 2012:

Thank you... not really what i was hoping to hear but i understand. I will tell the surgeon asap. We hadn't set a date for the surgery yet. Thank you for being so quick at responding, I appreciate it very much. Thank you.

TahoeDoc (author) from Lake Tahoe, California on May 30, 2012:

Hi Heather- Call your surgeon (who will correct the hip) right away and discuss this. Unless the surgery is to save life or limb (emergency), it is unlikely that they will do this while you are pregnant. It's very important that they know you are pregnant, obviously. Sorry for your pain and troubles :(

Heather on May 30, 2012:

I am needing to correct an improperly placed total hip replacement. Dr. offset me to the point that i appear disfigured and I am very uncomfortable due to the pain. I have a reason to suspect I am now a few weeks pregnant. I am a small athletic person. Just have hip displacia. Everyday is a struggle to walk. Is the possible pregnancy going to hault this corrective much desired surgery?

David from Idaho on May 28, 2012:

Pregnancy can be hard enough, throwing in surgery too would be unreal. Thankfully my wife made it through both of her pregnancies perfectly fine.

I liked how you broke down so many different variables than can affect a woman during her pregnancy.

Voted up and useful.

TahoeDoc (author) from Lake Tahoe, California on May 25, 2012:

Hi Amy- I'm glad everything turned out well for you and your son, although I'm sure it was very scary at the time! I appreciate your comments :)

Amy Gillie from Indiana on May 25, 2012:

I wish I had this much information six years ago when I had surgery at 20 weeks pregnant! Luckily everything turned out okay and my son is vibrant and smart as a whip! Thanks for sharing this peace of mind.

TahoeDoc (author) from Lake Tahoe, California on May 24, 2012:

You are right momaoak- you can never know for sure if or what the surgery/anesthesia contributed to your miscarriage. Miscarriages at that stage are incredibly common, but it's hard to say whether it would have happened without the surgery. No one could say for sure.

I'm sorry that happened. It's not really a consolation to tell you that it's really rare that the pregnancy test would be negative and that you would be the even more rare one to have a miscarriage. When you are THAT one, it doesn't matter what the statistics show about everyone else :(

Thanks for reading and I agree - only absolutely, no doubt about it, has to be done surgery - during pregnancy!

TahoeDoc (author) from Lake Tahoe, California on May 24, 2012:

Thank you Melis Ann! I hope it does help someone. I appreciate you reading and taking the time to comment :)

Melis Ann from Mom On A Health Hunt on May 24, 2012:

I find your hub on surgery while pregnant very informative. I'm sure someone facing this decision will find it useful to see the points you have detailed here. Voted up and useful!

momaoak from Greenwood, AR on May 24, 2012:

I had knee surgery when I was about 3-4 weeks pregnant. The test given at the hospital was negative so we didn't know I was pregnant till a few weeks later. I was under general anesthesia and took percocet after for pain. I ended up having a missed miscarriage-the baby failed to grow after 10 weeks. I still feel it might have been connected, but it was nobodies fault that is occurred. I would not risk surgery again unless I was 100% sure there was no way I could be pregnant, or it was a life or death situation.

TahoeDoc (author) from Lake Tahoe, California on May 24, 2012:

Thank you Robie. It isn't an everyday occurrence, but it does come up enough- the need to operate on pregnant women. No one enjoys the experience as it is stressful for all involved, but sometimes, it has to be done. And, it usually goes very well with no problems.

Robie Benve from Ohio on May 24, 2012:

Thank goodness I did not need anesthesia while pregnant, I would have been very anxious about it. It's good to read that the risks are actually lower than one thinks, when done properly. Great hub!