Elsevier

Current Problems in Surgery

Volume 38, Issue 4, April 2001, Pages A3, 223-290
Current Problems in Surgery

Surgery in the pregnant patient☆,☆☆,★,★★,♢,♢♢

https://doi.org/10.1067/msg.2001.112768Get rights and content

Section snippets

Maternal physiologic changes

Striae gravidarum (stretch marks) are common in pregnant patients and occur most often on the abdomen, breasts, thighs, and buttocks. They appear as red-to-purple linear depressions in the skin and represent tears in the collagen matrix. The cause of these striae is uncertain, and there is no effective prophylaxis against their development. Although they do not disappear completely, striae fade in the postpartum period.

A variety of vascular changes occur in the skin during pregnancy. The 2 most

Adnexal masses in pregnancy

Treatment of the adnexal mass in pregnancy presents a clinical dilemma of expectant treatment versus surgical intervention. Although specific recommendations for treatment have been made in the past, the clinical setting has changed. The patient population and cause of the masses have changed, in part because of delayed childbearing and the frequent use of ultrasound scanning in obstetric care. Therefore, the treatment of these patients must be reconsidered.

The adnexal mass in pregnancy has

Ectopic pregnancy

Ectopic pregnancy, defined as any gestation that develops outside of the endometrial cavity, is the leading cause of maternal death during the first trimester of pregnancy.76 Any practitioner who cares for reproductive-aged women should be familiar with the signs and symptoms of ectopic pregnancy and should also understand how to diagnose this condition. In addition, surgeons should be aware of and skilled in the various methods of treating patients who have an ectopic pregnancy.

Ninety-eight

Uterine emergencies that require surgical intervention

Postpartum hemorrhage is responsible for 30% of maternal deaths worldwide each year.99 Defined variably as an estimated blood loss of more than 500 mL in the first 24 hours after delivery,100, 101, 102 a decline in the hematocrit level of 10% between admission and the postpartum period,99 or the need for blood transfusion,99 postpartum hemorrhage complicates approximately 5% of vaginal deliveries103 and 6.4% of cesarean deliveries.99 Quantitation of blood loss is notoriously inaccurate, making

Appendicitis during pregnancy

Appendicitis is the most common nonobstetric surgical condition that complicates pregnancy.138 The incidence ranges from 1 per 1500 to 1 per 6600 pregnancies.139 The symptoms of nausea, vomiting, anorexia, and abdominal pain are so common in normal pregnancies that the diagnosis and treatment of appendicitis is often delayed. Concerns regarding the risks to the fetus and to the mother from operation performed unnecessarily also may delay intervention. Once the decision to operate has been made,

Trauma

Trauma is the leading nonobstetric cause of maternal death. Trauma occurs in approximately 7% of pregnancies. A review by Connolly and colleagues156 of pregnancies complicated by trauma from July 1987 through October 1993 at the University of North Carolina Hospitals in Chapel Hill, North Carolina, and the Women's Hospital in Greensboro, North Carolina, revealed a risk distribution of trauma cases: 54.6% were motor vehicle accidents; 22.3% were domestic abuse and assaults; 21.8% were associated

First page preview

First page preview
Click to open first page preview
View PDF

References (177)

  • K Higby et al.

    Do tocolytic agents stop preterm labor? A critical and comprehensive review of efficacy and safety

    Am J Obstet Gynecol

    (1993)
  • JG. Gianopoulos

    Establishing the criteria for anesthesia and other precautions for surgery during pregnancy

    Surg Clin North Am

    (1995)
  • AF Khazin et al.

    Effects of maternal hyperoxia on the fetus

    Am J Obstet Gynecol

    (1971)
  • JD Katz et al.

    Fetal heart rate monitoring in pregnant patients undergoing surgery

    Am J Obstet Gynecol

    (1976)
  • CE. Caverly

    Ovarian cyst complicating pregnancy

    Am J Obstet Gynecol

    (1931)
  • LW Hess et al.

    Adnexal mass occurring with intrauterine pregnancy: report of fifty-four patients requiring laparotomy for definitive management

    Am J Obstet Gynecol

    (1988)
  • WH Grimes et al.

    Ovarian cyst complicating pregnancy

    Am J Obstet Gynecol

    (1954)
  • GW Gustafson et al.

    Ovarian tumors complicating pregnancy

    Am J Obstet Gynecol

    (1954)
  • ED Grendys et al.

    Ovarian cancer in pregnancy

    Surg Clin North Am

    (1995)
  • P Whitecar et al.

    Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management

    Am J Obstet Gynecol

    (1999)
  • LM Bernhard et al.

    Predictors of persistence of adnexal masses in pregnancy

    Obstet Gynecol

    (1999)
  • A Barbati et al.

    Ontogeny of CA-125 antigen in pregnancy: immunoradiometric determination in amniotic fluid and immunohistochemical localization in fetal membranes

    Am J Obstet Gynecol

    (1989)
  • KC. White

    Ovarian tumors in pregnancy

    Am J Obstet Gynecol

    (1973)
  • JR Allen et al.

    Intra-abdominal surgery during pregnancy

    Am J Surg

    (1989)
  • RI Mazze et al.

    Reproductive outcome after anesthesia and operation during pregnancy: a registry of 5404 cases

    Am J Obstet Gynecol

    (1989)
  • L Guariglia et al.

    Ultrasound guided fine needle aspiration of ovarian cysts during pregnancy

    Eur J Obstet Gynecol Reprod Bio

    (1999)
  • RV Higgins et al.

    Comparison of fine-needle aspiration cytologic findings of ovarian cysts with ovarian histologic findings

    Am J Obstet Gynecol

    (1999)
  • M Andreoli et al.

    Laparoscopic surgery during pregnancy

    J Am Assoc Gynecol Laparosc

    (1999)
  • WH Parker et al.

    Laparoscopic management of benign cystic teratomas during pregnancy

    Am J Obstet Gynecol

    (1996)
  • S Akira et al.

    Gasless laparoscopic ovarian cystectomy during pregnancy: Comparison with laparotomy

    Am J Obstet Gynecol

    (1999)
  • D Soriano et al.

    Laparoscopy versus laparotomy in the management of adnexal masses during pregnancy

    Fertil Steril

    (1999)
  • C Nezhat et al.

    The risk of carbon monoxide poisoning after prolonged laparoscopic surgery

    Obstet Gynecol

    (1996)
  • T Tanaka et al.

    Treatment of interstitial ectopic pregnancy with methotrexate: report of a successful case

    Fertil Steril

    (1982)
  • TG Stovall et al.

    Single-dose methotrexate: an expanded clinical trial

    Am J Obstet Gynecol

    (1993)
  • M Yao et al.

    Current status of surgical and nonsurgical management of ectopic pregnancy

    Fertil Steril

    (1997)
  • J. Kjeldsen

    Hemodynamic investigations during labor and delivery

    Acta Obstet Gynecol Scand

    (1979)
  • U Elkayam et al.

    Hemodynamic and cardiac function during normal pregnancy and the puerperium

  • BK Howard et al.

    Supine hypotensive syndrome in late pregnancy

    Obstet Gynecol

    (1953)
  • DJ Dudley et al.

    Trauma and acute surgical emergencies in pregnancy

    Semin Perinatol

    (1990)
  • K O'Driscoll et al.

    Abruptio placentae and central venous pressures

    J Obstet Gynaecol Br Commonw

    (1966)
  • DP Cruikshank et al.

    Maternal physiology in pregnancy

  • M Enein et al.

    Echocardiography of the pericardium in pregnancy

    Obstet Gynecol

    (1987)
  • C Martin et al.

    Physiologic changes in pregnancy: surgical implications

    Clin Obstet Gynecol

    (1994)
  • DJ Taylor et al.

    Puerperal haematological indices

    Br J Obstet Gynaecol

    (1981)
  • RA Fay et al.

    Platelets in pregnancy: hyperdestruction in pregnancy

    Obstet Gynecol

    (1983)
  • SE Weinberger et al.

    Pregnancy and the lung

    Am Rev Respir Dis

    (1980)
  • JB Skatrud et al.

    Ventilatory response to medroxyprogesterone acetate in normal subjects: time course and mechanisms

    J Appl Physiol

    (1978)
  • RD Atlay et al.

    A fresh look at pregnancy heartburn

    J Obstet Gynaecol Br Commonw

    (1973)
  • AC Halvorsen et al.

    Acute appendicitis in pregnancy: complications and subsequent management

    Eur J Surg

    (1992)
  • AM Weber et al.

    Laparoscopic cholecystectomy during pregnancy

    Obstet Gynecol

    (1991)

    • Cited by (8)

    View all citing articles on Scopus
    ☆

    Barbara B. Bennett, MD, Associate Professor, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida

    ☆☆

    Daylene L. Ripley, MD, Assistant Professor, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida

    ★

    Judith S. Simms-Cendan, MD, Clinical Assistant Professor, Division of Gynecology, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida

    ★★

    John D. Davis, MD, Associate Professor and Director, Division of Gynecology, University of Florida College of Medicine, Gainesville, Florida

    ♢

    Juan C. Cendan, MD, Surgical Group of Gainesville, Gainesville, Florida

    ♢♢

    I. Keith Stone, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida

    View full text
    Copyright © 2001 Mosby, Inc. All rights reserved.