Non-Obstetric Surgery for the Pregnant Patient

As many as 50,000 pregnant women undergo anesthesia and surgery annually in the United States.11 This figure represents about 1.5% of pregnant women. After surgery related to trauma the acute abdomen is the most common nonobstetrical surgical problem in pregnancy with appendicitis ranking first among its causes.22 Maternal mortality associated with surgery during pregnancy was as high as 35% at the turn of the century but currently is not significantly greater than for surgery in nonpregnant women.7 Associated perinatal mortality ranges from 5.5–34.6%.7 In clinical situations separating the effects of anesthesia from those of surgery proves difficult. Although many animal studies link acute exposure to anesthesia with spontaneous abortion and congenital abnormalities variations in species, types and concentrations of anesthetic used, and duration of exposure cloud the significance of these studies for human pregnancy. Some human investigation hints at real problems related to exposure to anesthesia. Chairside dental assistants experience significant increases in spontaneous abortion and congenital anomalies compared to control subjects12 while operating room personnel and female anesthesiologists have spontaneous abortion rates of 1.3–3 times those of control groups.8,11