Anaes · Obstetric anaesthesia
Non-obstetric surgery in pregnancy: timing, conduct and fetal considerations
Also known as Surgery during pregnancy anaesthesia · Appendicectomy pregnancy · ACOG nonobstetric surgery · Second trimester elective surgery
Exam-exhaustive anaesthesia for non-obstetric surgery in pregnancy: ACOG timing principles, trimester physiology, aspiration and left uterine displacement, haemodynamic and CO2 goals, laparoscopy adaptations, fetal monitoring philosophy, VTE, and crisis pathways for ANZCA Final and secondary fellowship exams.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Do not deny indicated surgery because of pregnancy.
- Elective cases: prefer second trimester when feasible.
- Left uterine displacement after about 20 weeks.
- Maintain maternal BP and oxygenation for placental perfusion.
- Pregnancy hypercoagulability — plan VTE prophylaxis.
Meet the patient
A 28-year-old at 26 weeks gestation presents with peritonism and imaging consistent with acute appendicitis. The surgeon asks whether to wait until after delivery. The answer is no — an appendix delayed for the baby becomes maternal sepsis and fetal loss, the classic exam fail.[1]
The viva discriminators are not obscure teratology lists. They are the practical checklist: left uterine displacement after 20 weeks, aspiration readiness and obstetric-style airway thinking in late pregnancy, blood pressure near baseline for uteroplacental perfusion, controlled CO2 rather than aggressive hyperventilation, laparoscopy adaptations, fetal heart monitoring only when it will change management, and VTE prophylaxis because pregnancy is hypercoagulable.[2]
References4ShowHide
- [1]ACOG ACOG Committee Opinion No. 775: Nonobstetric Surgery During Pregnancy Obstet Gynecol, 2019.PMID 30913200
- [2]Reitman E, Flood P Anaesthetic considerations for non-obstetric surgery during pregnancy Br J Anaesth, 2011.PMID 22156272
- [3]Mushambi MC, Kinsella SM, Popat M, et al. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics Anaesthesia, 2015.PMID 26449292
- [4]Lee A, Ngan Kee WD, Gin T A quantitative, systematic review of randomized controlled trials of ephedrine versus phenylephrine for the management of hypotension during spinal anesthesia for cesarean delivery Anesth Analg, 2002.PMID 11916798