Statistics reveal that nearly 1 to 3 % of the pregnant women undergo surgery during their pregnancy for non-obstetric reasons and the major reasons for non-obstetric surgery are ovarian cystectomies, dental work, appendectomies or trauma. Now a day’s most of the pregnant women are working or travelling and are thus exposed to the trauma associated with vehicle accidents, knife wounds, broken bones etc.
Rarely neurological and cardiac problems affect the pregnant women and if it happens they may have to undergo surgery immediately during the period of the pregnancy itself. Women who have a tendency for abortion need to suture their uterus to continue the pregnancy and for this they should undergo anesthesia during the early second trimester.
Thus there are multiple reasons for surgery during pregnancy and the utterance of the word “surgery” send shivers down the spines of expected mothers. In certain cases the risks that happen to a fetus during a surgery may be not due to the anesthetic but because of the mother’s reaction to the surgery.
In all the above mentioned cases surgery becomes inevitable and while performing surgery doctors give priority to certain factors like management of maternal risk factors, maintenance of uteroplacental sufficiency, exposure to teratogens and the direct as well as indirect actions of maternally dispensed anesthetics on the wellbeing of the fetus.
Most of the doctors use regional anesthesia while operating a pregnant women instead of the general anesthesia. They also avoid all the non-compulsory surgeries during pregnancy. If the surgery is unavoidable but can be delayed then doctors postpone the surgery to second trimester or third trimester of pregnancy because the surgery during pregnancy may cause pre-term labor.
A cesarean at the time of delivery also requires anesthesia and may affect the baby. Since the anesthesia is also accompanied with surgery, antibiotics, X-rays, maternal stress and health condition of the patient the adverse outcome can’t be due to anesthetic alone.
Effect Of Anesthesia On Fetus
Almost all the anesthetic administrated during pregnancy cross the placenta and spread to the fetus and may affect the baby.Regional anesthesia reduces the exposure of fetus to anesthesia and hence is safer but in certain cases the usage of general anesthesia is only indicated.
Hence the most common anesthetic used during surgeries in pregnancy are epidurals which is a regional anesthetic that prevents the sensations by blocking the nerve impulses from the lower half of the body. After the administration of the epidural anesthesia certain babies become lethargic and won’t be able to move to a position for delivery but the medicine may not harm the baby.
Sometimes anesthesia may cause fetal distress that reduces the fetal cardiac output as well as the blood circulation. The oxygen delivery to fetus also gets affected and hence an emergency C-section becomes necessary to save the infant’s life. Any drop in mother’s oxygen saturation and blood pressure may also risk the fetus’s life.
A general or regional anesthesia given to pregnant women for non-obstructive surgery is only for a short period and the concentration of the anesthetic becomes minimal in mother’s as well as the baby’s body within in few minutes to hours after surgery. Hence the chances of having birth defects or fetal abnormalities or teratogenic effects due to anesthetic are minimal.
The chances of miscarriages or still birth are more if a surgery is conducted during the first trimester of pregnancy (10%). The chances for preterm labor after surgery during pregnancy are around 8 %. It may also cause reduced growth rate and low birth weight. Surgery and the associated anesthesia are safe for pregnant women and her chances to deliver a baby with birth defects are at par with any other pregnant woman.
But the anesthesia and surgery that is conducted during the first trimester increases her chances for miscarriage and still birth and a surgery that is conducted during the third trimester increases the chances of premature delivery. Hence while taking the decision to undergo a surgery consider all the pros and cons of undertaking surgery during that time of the pregnancy.