2% of pregnant women experience situations where they require surgery under anesthesia. There may be plenty of reasons for this: appendicitis, cholecystitis, ovarian cysts, bone fractures, dental diseases.
Some operations can be performed under local anesthesia, while for others only general anesthesia is suitable. Does anesthesia have a negative effect on the fetus, and what negative consequences can there be for the embryo?
Surgeons performing an operation on a pregnant woman
Safety of anesthesia for a pregnant woman
It has been statistically reliably established that the frequency of complications from anesthesia in pregnant women, including the most dangerous (anaphylactic shock and death), does not differ from the frequency of such complications in non-pregnant women.
In many ways, the safety of a pregnant woman during surgery depends on the qualifications of the anesthesiologist and on the provision of the operating room with the necessary equipment. The equipment standard includes:
- anesthesia machine with artificial lung ventilation function;
- a monitor that allows you to continuously monitor the most important vital parameters during surgery (blood pressure, pulse and respiration rates, degree of blood oxygen saturation);
- infusion pumps, which are used to continuously administer drugs into a vein;
- defibrillator
Operating room equipment
In the absence of this equipment, the life of a pregnant woman and her unborn child is exposed to unjustified risk.
Use of anesthesia during pregnancy
There is no doubt: the treatment of pregnant women requires special attention and careful selection of medications. This is true for surgery and (doubly!) for anesthesiology. There are no absolutely safe anesthetic drugs; they all have their own toxicity threshold, which they reach in certain doses. And in each specific case, the anesthesiologist needs to correctly calculate the dose in order to put the patient to sleep, make him insensitive to pain, completely relax all the muscles and even stop his breathing. But all this is only for the duration of the operation itself, after which the person must “wake up”.
Any surgical intervention and associated anesthesia carries a certain risk for any patient. What can we say about a woman carrying a child under her heart! Pregnancy significantly changes the functioning of almost all major organs and systems of a woman. She begins to breathe differently, her liver, kidneys and heart work harder, the composition of her blood changes, her immune system is partially suppressed, her digestive organs are forced to work in a “squeezed” state, etc. And all this changes as the pregnancy itself progresses. When choosing anesthesia, the doctor takes into account the permeability of the placenta for anesthetic drugs, the baby’s ability to “digest” anesthetic “cocktails” and their effect on the formation of a small organism. All this puts a pregnant woman in a special risk group.
Most often, a pregnant woman ends up on the surgical table due to injuries, acute surgical diseases of the abdominal organs (such as appendicitis), exacerbation of chronic surgical diseases and dental problems.
So, in the first and second trimesters, anesthetic drugs are more dangerous for the baby than for the mother, especially between the 2nd and 8th weeks of pregnancy. At this time, the formation of the baby’s main organs occurs, and most anesthetics (painkillers) pass through the placenta, inhibiting the growth and development of cells, thereby increasing the risk of deformities (terratogenic effect). In addition to this, due to the operation itself and the action of anesthetic drugs, placental and uterine blood flow is disrupted, and the child’s nutrition deteriorates.
Surgery is also important for the mother. Due to the release of adrenaline and other stress factors, the risk of miscarriage increases. The mother is more likely to vomit during surgery and have the vomit enter the lungs (aspiration) and develop severe pneumonia. Because of all these dangers, in the first and second trimesters, pregnant women are operated on under general anesthesia only for health reasons, that is, in cases where refusal to operate directly threatens the life of the mother. Minor surgeries can be performed under local anesthesia, where an anesthetic is injected directly into the site of the planned surgery (for example, emergency dental procedures). But even so, some of the anesthetic can reach the baby, and maternal pain can increase the tone of the uterus, worsen uteroplacental blood flow and increase the risk of miscarriage.
If necessary and if possible, doctors try to reschedule the operation to a later date - 14-28 weeks (second trimester), since at this time the child’s organs are formed, and the excitability of the uterus to external influences is minimal.
In the third trimester, the risk of miscarriage and life-threatening complications increases even more; the abdominal organs are displaced and “squeezed” by the uterus, which also puts pressure on the main blood vessels in the abdomen, disrupting blood flow. Increased pressure in the abdominal cavity is transferred to the chest cavity, reducing the volume of respiratory movements, and the need for oxygen, on the contrary, increases: the mother also breathes for the child. Therefore, if major surgical interventions are necessary, doctors try to wait until the child’s lungs mature. First, a caesarean section is performed in the usual manner, and then the necessary operation is performed.
Safety of anesthesia for the fetus
The risk of anesthesia for the fetus in the early stages is undeniable and is due to the influence of several factors. The effect of anesthesia used during surgery. Although doctors are now trying to use low-toxic drugs, it is impossible to completely protect the fetus from their influence. The effects of anesthesia are especially noticeable during the first trimester. The miscarriage rate in women undergoing general anesthesia is 3% higher than in the general population (11% versus 8%).
This phenomenon is due to the fact that in the first trimester the formation of the main organs and systems of the fetus occurs, and medications can inhibit this process.
This is interesting! Anesthesia does not increase the likelihood of congenital deformities in a child!
The mother’s hemodynamic state, that is, her pulse and blood pressure, has a huge impact on the fetus. Most anesthesia drugs lower blood pressure, which can have negative consequences for the fetus - blood flow in the utero-placental complex decreases. After anesthesia, pregnant women in the later stages (third trimester) increase the risk of premature birth. This is largely due not to the effects of drugs during anesthesia, but to the stress that the operation itself and the postoperative period pose for a pregnant woman.
During a caesarean section under general anesthesia, the newborn baby may experience respiratory depression due to the effects of narcotic anesthetics.
Indications
Of course, we are not talking about planned surgical interventions that can wait (for example, plastic surgery for the purpose of aesthetic correction of the body). But pregnant women may experience emergencies that cannot be resolved conservatively.
- Complex fractures with displacement.
- Attacks of appendicitis, cholecystitis, pancreatitis.
- Progressive suspicious neoplasms.
- Gynecological problems that interfere with the normal development of the fetus.
For pregnant women, some risks are automatically reduced because they begin to take care of themselves when they learn about their new status as expectant mothers. A woman in an interesting position will switch from heels to comfortable shoes, temporarily put off extreme sports, and begin to be more attentive to food and drinks. But not everything depends on it, and you can get into an accident, become a victim of an attack, or even break something just by turning awkwardly.
By the way! Fractures in pregnant women are not uncommon because most of the calcium is given to the fetus to form its skeletal system.
The following situation cannot be ruled out: a woman first planned an operation, and then found out that she was pregnant. What to do in this case? You need to contact the doctor who will be operating to assess the risks and determine whether the intervention can be postponed. If it concerns, for example, the removal of a dangerous tumor, then it is advisable to carry it out rather than worry about it throughout the entire pregnancy.
Anesthesia is harmful to any person because it is the effect of a mixture of chemicals on the body. But if a healthy, strong man endures general anesthesia relatively calmly and without consequences, then this can cause serious harm to a pregnant woman.
Anesthesia is especially dangerous in the early stages of pregnancy, when all organs and systems begin to form in the fetus. And these processes can be negatively affected by drugs used to put a pregnant woman into medicated sleep. The main risks consist of three factors.
- Increased uterine tone due to increased pressure. Sometimes this happens even at the preparation stage, because... Some women get too nervous.
- Fetal asphyxia due to decreased blood pressure and insufficient oxygen entering the blood.
- Child developmental disorders due to too much exposure to medications. And this is not necessarily an overdose: sometimes the fetus is initially very weak to resist anything.
It is unknown how the body of a pregnant woman will react to the administration of certain drugs. So surgery under anesthesia is always a risk. Therefore, doctors recommend planning a pregnancy and first undergoing a medical examination for all kinds of diseases that require surgical treatment.
Long-term effects of anesthesia
General anesthesia received during pregnancy does not affect the psychomotor development of the child.
It is safe to say that in women who have undergone general anesthesia during pregnancy, the child will not lag behind its peers in development. Claims that such a child has developmental or mental problems are idle fictions, refuted by numerous scientific studies.
There are also no consequences for the mother, but the benefits of anesthesia during pregnancy are undeniable - with the help of anesthesia, you can completely eliminate the impact of stress and pain on the mother and unborn child.
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According to medical statistics, only 2% of pregnant women face the need for anesthesia. There can be many reasons for this: developed appendicitis, a bone fracture, a cyst, or the need to remove a diseased tooth. We will talk about the safest medications and how to reduce the risk of unpleasant consequences.
How can you reduce the risks of anesthesia?
For pregnant women, some emergency operations can be performed under regional, spinal or epidural anesthesia. However, the question of choosing a method of pain relief should be decided together with a doctor, since only he can take into account all the indications and contraindications.
One way to minimize the effect of anesthetics on the unborn child is to use multicomponent anesthesia, in which drugs from different groups are used. This allows the concentration of each of these drugs to be reduced, which reduces their toxic effect.
Caesarean section, which is the most common operation in pregnant women, is currently 80% preferred by doctors to be performed under spinal anesthesia, which completely prevents the entry of anesthesia drugs into the child’s body.
To reduce all negative effects, doctors try to use drugs that do not pass through the uteroplacental barrier. It becomes easier to do this every year, as new, modern anesthetics, including inhalational ones, appear.
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Drugs
For anesthesia during pregnancy, a mixture of drugs is especially carefully selected, which should put the woman into a medicated sleep. Over many years of studying the effects of various solutions, it was found out how certain medications affect pregnant women during anesthesia:
- propofol, glycopyrrolate and morphine are safe in small doses;
- Atropine and metoclopramide are suitable for premedication;
- Thiopental can be used for induction of anesthesia;
- muscle relaxation is achieved by using esmeron;
- maintaining narcotic sleep is carried out using a mixture of sevoflurane plus fentanyl;
- drugs with adrenaline are contraindicated.
The anesthesiologist has an important task: to provide a pregnant woman with a smooth, medicated sleep, during which she will not feel anything physically and be psychologically aware. But at the same time, the anesthesia should not be allowed to be too deep, so as not to increase the concentration of chemicals entering the body.
By the way! The state of anesthesia is maintained by a constant supply of drugs into the body. Therefore, it is important to reduce the duration of the operation as much as possible in order to reduce the impact of chemicals on the woman and the fetus. For this purpose, pregnant women are sometimes operated on by several doctors at once.
Pain relief for expectant mothers - the best choice
Epidural anesthesia is considered the safest method of pain relief for mother and baby during pregnancy.
To carry it out, a needle is inserted through holes in the spinal canal directly above the dura mater of the spinal cord, into the epidural space - just where the nerve roots pass that carry pain impulses from the uterus. To make the procedure painless, the skin at the site of the intended injection is numbed before the injection. Then a special needle is inserted into which a thin silicone tube (catheter) is inserted; the needle is removed, and the catheter remains in the epidural space - a strong local anesthetic is injected into it. As needed, a medicinal substance can be added through the catheter, prolonging the analgesic effect to 24-36 hours.
During epidural anesthesia, the patient should be in the most bent position: lying on her stomach, bent over, or sitting, bending over.
After administration of the drug, pain relief develops within 10-20 minutes.
When the catheter is inserted, it may touch a nerve, causing a brief shooting sensation in the leg. Another thing that can accompany anesthesia is sometimes a feeling of numbness, weakness and heaviness in the legs.
The following complications may occur after this type of anesthesia:
- Headache appears on days 1-3 after anesthesia in approximately 1% of cases. If a headache occurs, anesthesiologists prescribe bed rest, fluids and painkillers.
- Skin itching may occur at the injection site, which can be treated by taking antihistamines under medical supervision.
- Due to the prolonged position on the back and the effect of the anesthetic on the intercostal muscles, the woman may have difficulty breathing. In this case, oxygen is prescribed through a special mask.
- When an anesthetic is injected into the veins of the epidural space, dizziness, palpitations, a metallic taste in the mouth, and numbness of the tongue may occur. In order to prevent these unpleasant sensations, a test dose is first administered to the woman before the entire volume of the anesthetic is administered.
- Sometimes the effect of the anesthetic may affect only one half of the body. This can be easily corrected by tightening the catheter slightly.
Contraindications for epidural anesthesia are:
- sepsis;
- skin infection at the site of the intended injection;
- blood clotting disorder (before epidural anesthesia, a blood clotting test is performed);
- bleeding;
- neurological diseases;
- patient's refusal of pain relief.
For minor operations performed in the third trimester, other types of local anesthesia may be used. They are less dangerous at this time than at the beginning of pregnancy because the risk to the baby decreases as it develops.
Features of scar formation on the uterus after surgery
The course of pregnancy and upcoming birth depends on the condition of the uterine scar after removal of fibroids. This is a key factor in determining the answers to the following important questions:
- When will it be possible to plan a pregnancy?
- How will the pregnancy proceed?
- Can I give birth on my own or will I have to have a caesarean section?
The results of numerous studies show that a day after the operation, the edges of the wound stick together and regeneration processes begin. On the first day, new blood and lymphatic vessels are formed at the site of the incision and myocytes are actively multiplying. After 7 days, collagen production increases and elastic fibers appear. By the end of the third week, the growth of muscle cells into the damaged area ends, and the tissue structure is restored. If all processes went well, a full-fledged scar on the uterus is formed. When a well-functioning mechanism fails, atrophy of muscle fibers occurs, and instead of complete healing of the tissues, their sclerosis occurs.
After removal of uterine fibroids, a full-fledged scar is formed within a month, provided that the tissue restoration algorithm is not disrupted.
Assessment of the formed scar on the uterus is carried out using ultrasound. A scar that meets the following criteria is considered complete:
- Thickness from 5 mm;
- A clearly defined layer of muscle tissue along the entire length of the scar;
- Absence of local thinning in the study area.
The main thing is caution!
Thus, surgical treatment methods and their anesthesia for a pregnant woman are complex and dangerous, but sometimes they cannot be avoided. There is only one way out in this situation: take care of yourself! Try to deal with your chronic diseases that require surgery before pregnancy. Don’t forget about dental problems: sad as it may be, one of the reasons for abortions and premature births is dental intervention during pregnancy, especially acute conditions, that is, dental diseases that cause toothache. Their treatment, as a rule, is also associated with pain. However, most of these diseases can be prevented by treatment before testing.
Try to avoid places that are dangerous for injury. If you are busy in production, ask management to comply with the Labor Code and transfer to a quiet area. Please note that a car is not the safest place in the city, and even if an ace is driving your car, it is possible that your neighbor on the highway will be a reckless driver. During pregnancy, you should sacrifice panache for convenience: hide thin stilettos, high heels and slippery soles away in the closet. Wear comfortable and stable shoes. Reduce for yourself and for your unborn child the risk of injury in the apartment (sharp corners, boxes falling from mezzanines, swinging stepladders and stools, etc.).
But if the need for surgical intervention does arise, do not delay, consult a doctor. Take care of yourself and your baby.
For medical questions, be sure to consult your doctor first
