Evaluation and Management of Patients Requiring Non-Obstetrical Abdominal Surgery during Pregnancy: A Framework

Shields A, de Assis V, Halscott T. Top 10 pearls for the recognition, evaluation, and management of maternal Sepsis. Obstet Gynecol. 2021;138(2):289–304. https://doi.org/10.1097/aog.0000000000004471.

Article  PubMed  PubMed Central  Google Scholar 

Tolcher MC, Fisher WE, Clark SL. Nonobstetric surgery during pregnancy. Obstet Gynecol. 2018;132(2):395–403. https://doi.org/10.1097/aog.0000000000002748.

Article  PubMed  Google Scholar 

Traweek R, Phan V, Griesbach C, Hall C. General surgery during pregnancy and gynecologic emergencies. W.B. Saunders; 2023. pp. 1217–29.

Skubic JJ, Salim A. Emergency general surgery in pregnancy. Trauma Surg Acute Care Open. 2017;2(1):e000125. https://doi.org/10.1136/tsaco-2017-000125.

Article  PubMed  PubMed Central  Google Scholar 

Arkenbosch JHC, van Ruler O, de Vries AC. Non-obstetric surgery in pregnancy (including bowel surgery and gallbladder surgery). Best Pract Res Clin Gastroenterol. 2020;44–45:101669. https://doi.org/10.1016/j.bpg.2020.101669.

Article  PubMed  Google Scholar 

Committee Opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210–6. https://doi.org/10.1097/aog.0000000000002355.

Article  Google Scholar 

Marquez A, Wasfie T, Korbitz H, Wong V, Pearson E, Holsinger H, et al. Role of abdominal ultrasound and magnetic resonance imaging in pregnant women presenting with acute abdominal pain. Am Surg. 2022;88(8):1875–8. https://doi.org/10.1177/00031348221087914.

Article  PubMed  Google Scholar 

Baruch Y, Canetti M, Blecher Y, Yogev Y, Grisaru D, Michaan N. The diagnostic accuracy of ultrasound in the diagnosis of acute appendicitis in pregnancy. J Matern Fetal Neonatal Med. 2020;33(23):3929–34. https://doi.org/10.1080/14767058.2019.1592154.

Article  PubMed  Google Scholar 

Ray JG, Vermeulen MJ, Bharatha A, Montanera WJ, Park AL. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952–61. https://doi.org/10.1001/jama.2016.12126.

Article  PubMed  Google Scholar 

Smith-Bindman R, Chu PW, Azman Firdaus H, Stewart C, Malekhedayat M, Alber S, et al. Projected lifetime Cancer risks from current computed tomography imaging. JAMA Intern Med. 2025. https://doi.org/10.1001/jamainternmed.2025.0505.

Article  PubMed  PubMed Central  Google Scholar 

Medicine AAoPi. AAPM Position Statement on the Use of Patient Gonadal and Fetal Shielding. https://www.aapm.org/org/policies/details.asp?type=PP&id=2552 (2019). Accessed May 12 2025.

ACOG Committee Opinion No. 775: nonobstetric surgery during pregnancy. Obstet Gynecol. 2019;133(4).

Po’ G, Olivieri C, Rose CH, Saccone G, McCurdy R, Berghella V. Intraoperative fetal heart monitoring for non-obstetric surgery: A systematic review. Eur J Obstet Gynecol Reproductive Biology. 2019;238:12–9. https://doi.org/10.1016/j.ejogrb.2019.04.033.

Article  Google Scholar 

Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005;190(3):467–73. https://doi.org/10.1016/j.amjsurg.2005.03.033.

Article  PubMed  Google Scholar 

Shepherd ES, Goldsmith S, Doyle LW, Middleton P, Marret S, Rouse DJ, et al. Magnesium sulfate before preterm birth for neuroprotection: an updated Cochrane systematic review. Obstet Gynecol. 2024;144(2):161–70. https://doi.org/10.1097/aog.0000000000005644.

Article  PubMed  PubMed Central  Google Scholar 

Shennan A, Suff N, Jacobsson B, Simpson JL, Norman J, Grobman WA, et al. Abstracts of the XXIII FIGO world Congress of gynecology & obstetrics. Int J Gynaecol Obstet. 2021;155(Suppl 2):31–532. https://doi.org/10.1002/ijgo.13884.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Committee Opinion No. 455: Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol. 2010;115(3):669– 71. https://doi.org/10.1097/AOG.0b013e3181d4ffa5

Hong JY, Park JW, Oh JI. Comparison of preoperative gastric contents and serum Gastrin concentrations in pregnant and nonpregnant women. J Clin Anesth. 2005;17(6):451–5. https://doi.org/10.1016/j.jclinane.2004.10.010.

Article  CAS  PubMed  Google Scholar 

Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011;107(Suppl 1):i72–8. https://doi.org/10.1093/bja/aer343.

Article  PubMed  Google Scholar 

Devroe S, Bleeser T, Van de Velde M, Verbrugge L, De Buck F, Deprest J, et al. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study. Int J Obstet Anesth. 2019;39:74–81. https://doi.org/10.1016/j.ijoa.2019.01.006.

Article  CAS  PubMed  Google Scholar 

Pilkington S, Carli F, Dakin MJ, Romney M, De Witt KA, Doré CJ, et al. Increase in Mallampati score during pregnancy. Br J Anaesth. 1995;74(6):638–42. https://doi.org/10.1093/bja/74.6.638.

Article  CAS  PubMed  Google Scholar 

Chan MT, Mainland P, Gin T. Minimum alveolar concentration of halothane and enflurane are decreased in early pregnancy. Anesthesiology. 1996;85(4):782–6. https://doi.org/10.1097/00000542-199610000-00013.

Article  CAS  PubMed  Google Scholar 

Radkowski P, Jacewicz M, Podhorodecka K. The use of muscle relaxants in pregnancy and puerperium period. Int J Gen Med. 2023;16:859–64. https://doi.org/10.2147/ijgm.S393885.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Willett AW, Butwick AJ, Togioka B, Bensadigh B, Hofer J, Zakowski M. Society for obstetric anesthesia and perinatology statement on Sugammadex during pregnancy and lactation. https://www.soap.org/assets/docs/SOAP_Statement_Sugammadex_During_Pregnancy_Lactation_APPROVED.pdf (2019). Accessed 5/18/2025 2025.

Weinstein MS, Feuerwerker S, Baxter JK. Appendicitis and cholecystitis in pregnancy. Clin Obstet Gynecol. 2020;63(2):405–15. https://doi.org/10.1097/grf.0000000000000529.

Article  PubMed  Google Scholar 

Kumar SS, Collings AT, Wunker C, Athanasiadis DI, DeLong CG, Hong JS, et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2024;38(6):2947–63. https://doi.org/10.1007/s00464-024-10810-1.

Article  PubMed  PubMed Central  Google Scholar 

Pearl JP, Price RR, Tonkin AE, Richardson WS, Stefanidis D. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2017;31(10):3767–82. https://doi.org/10.1007/s00464-017-5637-3.

Article  PubMed  Google Scholar 

Ashbrook MJ, Cheng V, Longo E, Kohrman N, Matsuo K, Martin MJ, et al. Management of adhesive small bowel obstruction during pregnancy in the united States. J Trauma Acute Care Surg. 2025. https://doi.org/10.1097/ta.0000000000004518.

Article  PubMed  Google Scholar 

Cheng V, Ashbrook M, Youssefzadeh AC, Kohrman N, Matsuo K, Inaba K, et al. Management for acute uncomplicated appendicitis during pregnancy: National trends and patient outcomes. Ann Surg. 2023;278(6):932–6. https://doi.org/10.1097/sla.0000000000005893.

Article  PubMed  Google Scholar 

Crowhurst J, Whitby M. Lowering fluoroscopy pulse rates to reduce radiation dose during cardiac procedures. J Med Radiat Sci. 2018;65(4):247–9. https://doi.org/10.1002/jmrs.312.

Article  PubMed  PubMed Central  Google Scholar 

REPROTOX, Dexamethasone REPROTOX. Truven Health Analytics.

REPROTOX, Ondansetron REPROTOX. Truven Health Analytics.

ACOG Practice Bulletin No. 189: nausea and vomiting of pregnancy. Obstet Gynecol. 2018;131(1):e15–30. https://doi.org/10.1097/aog.0000000000002456.

Article  Google Scholar 

Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859–71. https://doi.org/10.1111/j.1526-4637.2010.00983.x.

Article  PubMed  Google Scholar 

Koo C-H, Kim J, Na H-S, Ryu J-H, Shin H-J. The effect of Lidocaine patch for postoperative pain: A meta-analysis of randomized controlled trials. J Clin Anesth. 2022;81:110918. https://doi.org/10.1016/j.jclinane.2022.110918.

Article  CAS  PubMed  Google Scholar 

Dathe K, Hultzsch S, Pritchard LW, Schaefer C. Risk Estimation of fetal adverse effects after short-term second trimester exposure to non-steroidal anti-inflammatory drugs: a literature review. Eur J Clin Pharmacol. 2019;75(10):1347–53. https://doi.org/10.1007/s00228-019-02712-2.

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