What if You Need Anesthesia and Surgery While Pregnant?

Having surgery while pregnant is stressful and sometimes risky, but your doctors are trained to minimize the risk to you and your baby.
Having surgery while pregnant is stressful and sometimes risky, but your doctors are trained to minimize the risk to you and your baby. | Source

What if I Need Surgery While I'm Pregnant?

Only very necessary surgery is performed on pregnant women. As expected, there are risks to both the mother and fetus from the stress of surgery and anesthesia, and from direct effects of both. Before deciding to operate on a pregnant woman, it must be clear that the risks of NOT operating outweigh the risks of doing so.

As a physician anesthesiologist, I know that there will need to be a team-approach and discussion about the risks and benefits of how and when to do the surgery. We take this approach each time to keep you and your baby as safe as possible if you need to have surgery while you are pregnant.

It is not a decision that is entered into lightly. If your surgeon or obstetrician says you need surgery, you probably do. If you aren't comfortable with their decision, you can ask for another opinion, but this may not be practical in an urgent situation.

(From the anesthesiologists point of view, it usually goes something like this... "Doctor, we have an add-on surgery for you. The patient is a healthy 30 year old and needs to have her appendix out as she is having pain and has signs of infection. Oh, and by the way, she's pregnant.")

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The Most Common Nonobstetric Surgeries on Pregnant Women

  • Appendectomy
  • Cholecystectomy (removing gall bladder)
  • Ovarian Surgery (often for twisted ovary)
  • Trauma Surgery after an accident
  • Cervical Surgery (especially "cerclage" to prevent preterm delivery)
  • Breast Surgery (when it can't be delayed until after pregnancy)
  • Emergency Surgery for Dangerous Bowel Obstruction

What are the Most Common Surgeries on Pregnant Women?

In the United States, about 80,000 surgeries are performed on pregnant women each year. This means that 1 to 2 percent of women will undergo surgery while pregnant.

As in the example, appendicitis is the most common reason for a woman to have surgery while pregnant. Appendectomy on a pregnant woman can be done by either a laparoscopic (camera and instruments placed through small incisions) or open (one incision in the right lower abdomen). Both techniques have advantages and disadvantages and you should discuss this with your surgeon as each case must be decided on its own specifications.

Gallbladder surgery usually can be delayed until after delivery with pain managed medically during pregnancy. Occasionally, the gallbladder is so inflamed, blocked by stones or infected that it has to come out to prevent more serious illness. This is usually done laparoscopically.

Ovarian torsion (twisting) causes severe pain and puts the ovary at risk of "dying" by cutting off its blood supply. Ovarian cysts are also relatively common during pregnancy. Laparoscopic surgery is usually the method of choice for ovarian surgery when pregnant.

Cervical cerclage is done during pregnancy to prevent the cervix from dilating and leading to a resultant preterm delivery.

Trauma surgery usually follows a motor vehicle accident, although other accidents may also require surgery.

Breast and bowel surgery may also have to happen on an urgent or emergent basis.

Risks to Mother of Non-Obstetric Surgery While Pregnant

There are traits of pregnancy that make anesthesia more risky. Changes in nearly every organ system occur due to hormonal and anatomic alterations. Anesthesiologists study these changes in detail and are prepared to provide anesthesia with the anatomy and physiology of the pregnant woman in mind.

Airway: Because pregnant women retain water, their soft tissue and mucosa around the airway (nose, mouth, throat) tend to "swell". This can make placement of a breathing tube more difficult. Indeed, this is one of the most dreaded obstacles for anesthesiologists. Once asleep, there is limited time to place the breathing tube and resume oxygen delivery before mom and baby are at risk. Luckily, our training includes recognition of and planning for this situation.

Swelling of the tissues around and over the windpipe can also present danger after surgery. Oxygen levels and breathing are monitored closely in the recovery room to make sure this isn't an issue.

Also, blood supply is increased to the airway of pregnant women and the soft tissues are more sensitive and fragile. Bleeding of the mucosa (lining) of the mouth or throat can cause the above difficult airway, or it may lead to irritation of the vocal cords (causing them to spasm closed after removal of the breathing tube, making oxygen delivery difficult).

Anesthetic Concerns: Your anesthesiologist is trained to know that the required amount of anesthesia is reduced by up to 40% during pregnancy. He or she will monitor you carefully to make sure you don't get too much -- or too little -- anesthesia.

Aspiration:By the 16th week of gestation, changes in the gastrointestinal system make heartburn and acid reflux very common. Even asymptomatic pregnant women are considered to be at risk. In the third trimester, the additional pressure placed on the stomach by the lower abdomen adds to the likelihood that acid could be pushed up from the stomach into the esophagus and all the way up to the throat where it can enter the windpipe and lungs.

Blood Pressure: A pregnant woman has a higher volume of fluid and blood circulating in her system. But, hormonal changes cause the blood vessels to relax a bit. The overall effect is a lower blood pressure that may decrease even more under anesthesia. Because a too-low blood pressure puts the baby at risk of not getting enough blood and oxygen, this is monitored and maintained very carefully by the anesthesiologist.

Breathing: While the breathing tube is in place (and it will be for general anesthesia), the ventilator can help you breathe. After surgery, you must take over this function again. Your oxygen reserves are reduced during pregnancy. Also, a large uterus can make it difficult to take deep breaths, especially while you are groggy. You will be monitored and reminded to do this regularly so your (and baby's) oxygen level doesn't drop.

Recovery: In the recovery period, your baby may be at risk of arriving early. This is especially true if you had to have surgery in the third trimester. The nurses in recovery (or on the OB unit) can monitor your uterine contractions and the baby's heart rate. Medications can be given if contractions start.

The risk of preterm delivery may persist for the rest of pregnancy. In addition, pregnant women are more prone to blood clots in their legs and lungs after surgery and should be encouraged to walk as their surgical and obstetric conditions allow.

Facts about Appendicitis in Pregnancy for Doctors

Risks to Fetus of Nonobstetric Surgery While Pregnant

Of course, all of the factors that cause complications in the mother, also put the baby at risk. The biggest concerns for the baby are BIRTH DEFECTS, MISCARRIAGE AND PRETERM DELIVERY.

BIRTH DEFECTS: There is no evidence that babies born to mothers who had surgery during pregnancy have a higher incidence of birth defects. Of course, designing a study where pregnant women are unnecessarily exposed to anesthesia and surgery, to establish this definitively is impossible to do (ethically). There is potentially some evidence that lower-birth weight may occur in these babies.

MISCARRIAGE: Miscarriage occurs in 1 to 2 percent of women who have surgery during pregnancy. It is unclear whether this is precipitated by the illness, the surgical procedure/manipulation or the anesthesia, or a combination.

PRETERM LABOR: As above, it is unclear why the risk of preterm labor seems to be increased, but most studies show a small increased risk of preterm labor after surgery in pregnant women. Some researches believe that anesthesia gases may relax the uterus and help prevent preterm labor, and therefore, recommend general anesthesia (as opposed to spinal or epidural).


The second trimester is considered the best time to perform surgeries on pregnant women that are necessary but not emergent. Organ development in the first trimester means there is a (theoretical) risk of abnormal development. By the third trimester, the risk of preterm contractions and delivery is increased.

One Woman's Story - Appendicitis during Pregnancy


  • Obtain an obstetrics consult
  • Provide preop aspiration prophylaxis
  • Consider intraoperative, continuous fetal heart rate monitoring
  • Ensure left uterine displacement to maintain blood flow to uterus and placenta, especially after 20 weeks gestation
  • Preoxygenate fully
  • Perform a rapid sequence induction with difficult airway plans and equipment immediately available (ETT is mandatory after about 16 weeks)
  • Use smaller endotracheal tubes
  • Consider prepping before induction to minimize anesthesia time
  • Maintain hemodynamics and CO2 carefully (obviously)
  • Reassure your anxious patient that anesthesia during pregnancy is much safer than most people realize and problems are relatively rare

Recommendations from the Amercian Society of Anesthesiologists and American College of Obstetrics and Gynecology

The joint statement boils down to a few key points.

  1. Obtain an obstetrics consult
  2. No standard anesthetic agent is known to be teratogenic for a one-time exposure
  3. Urgent, but non-emergent surgery should be delayed until the 2nd trimester, when possible.
  4. Monitor the fetus with continuous heart rate and contraction monitoring IF
  • the fetus is of viable gestational age (or positioning will be aided by monitoring)
  • an obstetrician is available to intervene
  • the patient consents to emergency c-section delivery and
  • it is possible to do so
  • otherwise, check fetal heart tones and uterine contractions before and after surgery


All in all, women tend to feel reassured after learning the facts about anesthesia and surgery during pregnancy. There is some risk, but it really tends to be lower than most people expect. Also, knowing that the doctors and nurses have faced this dilemma before helps the understandably anxious mother-to-be.

Feel free to leave comments or questions as I try to answer each one personally.

Comments 29 comments

Robie Benve profile image

Robie Benve 4 years ago from Ohio

Thank goodness I did not need anesthesia while pregnant, I would have been very anxious about it. It's good to read that the risks are actually lower than one thinks, when done properly. Great hub!

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

Thank you Robie. It isn't an everyday occurrence, but it does come up enough- the need to operate on pregnant women. No one enjoys the experience as it is stressful for all involved, but sometimes, it has to be done. And, it usually goes very well with no problems.

momaoak profile image

momaoak 4 years ago from Greenwood, AR

I had knee surgery when I was about 3-4 weeks pregnant. The test given at the hospital was negative so we didn't know I was pregnant till a few weeks later. I was under general anesthesia and took percocet after for pain. I ended up having a missed miscarriage-the baby failed to grow after 10 weeks. I still feel it might have been connected, but it was nobodies fault that is occurred. I would not risk surgery again unless I was 100% sure there was no way I could be pregnant, or it was a life or death situation.

Melis Ann profile image

Melis Ann 4 years ago from Mom On A Health Hunt

I find your hub on surgery while pregnant very informative. I'm sure someone facing this decision will find it useful to see the points you have detailed here. Voted up and useful!

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

Thank you Melis Ann! I hope it does help someone. I appreciate you reading and taking the time to comment :)

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

You are right momaoak- you can never know for sure if or what the surgery/anesthesia contributed to your miscarriage. Miscarriages at that stage are incredibly common, but it's hard to say whether it would have happened without the surgery. No one could say for sure.

I'm sorry that happened. It's not really a consolation to tell you that it's really rare that the pregnancy test would be negative and that you would be the even more rare one to have a miscarriage. When you are THAT one, it doesn't matter what the statistics show about everyone else :(

Thanks for reading and I agree - only absolutely, no doubt about it, has to be done surgery - during pregnancy!

Amy Gillie profile image

Amy Gillie 4 years ago from Indiana

I wish I had this much information six years ago when I had surgery at 20 weeks pregnant! Luckily everything turned out okay and my son is vibrant and smart as a whip! Thanks for sharing this peace of mind.

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

Hi Amy- I'm glad everything turned out well for you and your son, although I'm sure it was very scary at the time! I appreciate your comments :)

adjkp25 profile image

adjkp25 4 years ago from Northern California

Pregnancy can be hard enough, throwing in surgery too would be unreal. Thankfully my wife made it through both of her pregnancies perfectly fine.

I liked how you broke down so many different variables than can affect a woman during her pregnancy.

Voted up and useful.

Heather 4 years ago

I am needing to correct an improperly placed total hip replacement. Dr. offset me to the point that i appear disfigured and I am very uncomfortable due to the pain. I have a reason to suspect I am now a few weeks pregnant. I am a small athletic person. Just have hip displacia. Everyday is a struggle to walk. Is the possible pregnancy going to hault this corrective much desired surgery?

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

Hi Heather- Call your surgeon (who will correct the hip) right away and discuss this. Unless the surgery is to save life or limb (emergency), it is unlikely that they will do this while you are pregnant. It's very important that they know you are pregnant, obviously. Sorry for your pain and troubles :(

Heather 4 years ago

Thank you... not really what i was hoping to hear but i understand. I will tell the surgeon asap. We hadn't set a date for the surgery yet. Thank you for being so quick at responding, I appreciate it very much. Thank you.

TahoeDoc profile image

TahoeDoc 4 years ago from Lake Tahoe, California Author

Good luck to you Heather!

gonch 3 years ago

I just got inseminated on Sat 2-23 and I will be needing meniscus surgery on 3-12. So if it takes and I am pregnant then I would be approximately 2weeks pregnant. Since it is so early would this damge my pregnancy?

TahoeDoc profile image

TahoeDoc 3 years ago from Lake Tahoe, California Author

Elective surgery is NOT recommended during pregnancy at all, and really not during early pregnancy. Please inform your OB/Gyn or Fertility doctor AND the orthopedic surgeon of your plans ASAP!

Carrie 3 years ago

Thank-you so much for your article! I have looking for hours trying to find an answer where they talked in detail about this subject. I just found out I am pregnant and I am in desperate need of knee surgery that I am supposed to have later this month at Mayo. I will most likely postpone it now, even though it may put me on bed rest by 20 weeks. My knee is completely shot but my pregnancy is more important!

TahoeDoc profile image

TahoeDoc 3 years ago from Lake Tahoe, California Author

Carrie- Thank you for letting me know this helped you. That is exactly why I wrote these articles so that is very satisfying for me. It can be so hard to get answers that are directed to patients.

Good luck with everything! And, congrats!

Selina 3 years ago

Thank you for the information. I am 11 weeks pregnant and have scheduled knee surgery at 14 weeks pregnant. My OBGYN says to go ahead, and my Orthopedic surgeon say it is fine. I have also spoke with about four other doctors, surgeons and OBs. I just received a call from the anesthesiologist who has scared me out of it. I am very torn, I can't imagine 7 more months of pain with this knee, then getting surgery once I have a new baby, but I also don't want to something selfish and endanger my child. What is your opinion? Should I go ahead and get my ACL fixed? I was planning on getting a spinal rather than being fully knocked out. Is this safer?

sunita 2 years ago

Good luck

TahoeDoc profile image

TahoeDoc 2 years ago from Lake Tahoe, California Author

Selina- I'm so sorry- some glitch is preventing comments from showing up in some of my hubs and I just saw your question from months ago.

If you happen to see this, which I highly doubt, please let me know what y our did and how you are doing.

Brian 2 years ago

What about getting your tonsils removed and adenoids or whatever their called ?

TahoeDoc profile image

TahoeDoc 2 years ago from Lake Tahoe, California Author

Hi Brian,

Tonsillectomy and adenoidectomy are not considered essential surgeries. I would think they should wait until after the baby is born. While this is considered 'routine' surgery, there is still a significant risk of bleeding, especially in an adult who is pregnant. Pregnant women are known to have increased vasculature (blood supply) and bleeding after tonsil surgery is a life-threatening emergency that would compromise the life of the mother and baby.

If there are extenuating circumstances for why this would be considered during pregnancy, that is something to discuss with the head and neck surgeon, ob-gyn and anesthesiologist who agree to undertake this risk.

Rachel 2 years ago

I shattered my tibial plateau skiing and it's bad! I had surgery scheduled for Friday and found out as I was going into surgery that I am pregnant. My doctor sent me home and postponed my surgery until Monday so I could process the risks. It is not an option to not have surgery. I can't walk and will be unable to until I have surgery. If I wait, a total knee replacement will be my only option and at 30 that's highly unadvisable. Instead of general anesthesia, I will only be numb from the waist down. My understanding is that there is a less than 2% chance of an issue. Know if anyone else that's been in this situation? Carrying a baby for 9 months while not being able to walk or care for myself seems to be the bigger risk.

TahoeDoc profile image

TahoeDoc 2 years ago from Lake Tahoe, California Author

Hi Rachel,

It does seem in your case that surgery cannot be delayed and any small risk will be well worth the mobility and recovered function while pregnant and caring for a newborn. It sounds like you will have a spinal or epidural for your surgery-those are great choices, but even if you have to have general anesthesia, it will likely be ok. I know this is scary and not ideal, but it is true that the risk of any issue is very, very low. You need to take care of your baby and if you are in your first trimester, better to get it done and heal now.

Good luck and I can't imagine how you must feel trying to process everything. Get well soon & congrats on the pregnancy!

Venus 2 years ago

Hi, I am 7 weeks pregnant now and suspected to have perforation in my uterus that I might have acquired when I had my D & C a year ago. My doctor referred me to an OB/ Radiologist to have a 2nd opinion and she's not sure as well what's inside my uterus but she said the nearest case is uterine perforation. My doctor is suggesting to have a diagnostic laparoscopy to see how serious the damage is and confirm that it is really perforation, since I am at risk of uterine rupture. After the procedure and when the perforation is confirmed the doctor will do an open surgery to "stitch" the perforation.

After reading your article, i feel a little bit relieved but the I am still worried. I have consulted as well an OB friend way back in the Philippines, she said that just to follow my doctors advice since he has all my records, but seek for a 2nd opinion with a Filipino doctor a Sonologist one. She also advised to delay the Laparoscopy procedure until you reach the second trimester coz you'll be at risk of miscarriage.

I just need your opinion as a professional regarding what type of anesthesia is applied on laparoscopy and if ever i will undergo surgery what is the assurance that the stitches inside the uterus and the stitches on my abdomen, where the entry for the surgery takes place, will not collapse or open?

TahoeDoc profile image

TahoeDoc 2 years ago from Lake Tahoe, California Author

Hi Venus-

This is a complicated problem, to be sure. BUT, your doctor really will have the best advice for you- you can certainly get a second opinion, but if they suspect a perforation, you don't want to risk rupture as the baby grows.

I am not an obstetrician so I'm not sure how much more risk there is to the uterus (and you and baby) if you wait till the second trimester, so you will have to go with your/specialist obstetrician's advice on this.

I'm not sure where you are located, but if possible, I would make sure you are getting these opinions and the surgery from experienced obstetricians- perhaps at a specialty maternity hospital or department that deals frequently with high-risk pregnancies and not a general obstetrician. I don't know if having to do an open surgery to repair the perf is normal (it may be due to the positioning of the uterus, I just don't know), but again, get the opinion from a reputable doctor and center- you can ask for a referral to a high-risk obstetrics practice if you aren't already at one. There are docs who specialize in high-risk pregnancy.

When you have your surgery, you will most likely have general anesthesia since it is laparoscopic surgery. Again, if you are at a center that does uterine surgery during pregnancy, they may have different protocols, but I doubt it.

Once they repair the perforation, it should be ok for the pregnancy. It may be one reason they'd want to do this sooner than later- the suture line will become stronger over timeā€¦Again, your doctors (specialists if possible) will be the best judges of this.

Good luck to you- I hope everything turns out great- I bet it will !!

Steph 2 years ago

I really appreciate this article - I'll be reading it over and over again in the upcoming days. I'm 24 weeks pregnant and just found out I have thyroid cancer. Two cancerous masses, one of which is pretty large and growing quickly. My endocrinologist wants me to do the surgery to remove my thyroid ASAP - before my third trimester begins. I'm, of course, very nervous about how my little one will do. This article was very reassuring that the effects of anesthesia aren't as bad as I think they are. I haven't met with the surgeon yet, so I'll have to wait and see if all doctors are on the same page for how to proceed.

It's hard to balance what is safest for mom AND safest for baby. This article has made me feel more confident that things will probably be OK with this surgery.

Thank you for taking the time to write this. :)

Kayla 16 months ago

Thank you for taking the time to write this. Last week, at 10 weeks pregnant, I had emergency, exploratory surgery via laproscopy. They took me back to surgery so quickly, my family didn't even have time to arrive to the hospital. It ended up being appendicitis and I had fluid around my uterus, most likely due to my inflamed appendix. Now even knowing I needed the surgery and that the benefits outweighed the risks, I still feel guilty and petrified. I have heard the heartbeat twice since surgery. I have another appointment today and Friday where I am sure they will listen again, I am still scared. Your article made me feel much more relaxed about the whole situation. Thank you again from the bottom of my heart.

Monae 14 months ago

Hi, I have completely torn my ACL. I am 5 weeks pregnant and I am in the military. The military is not going to let me wait a year for me to have surgery and I am due to transfer soon. I am very nervous and I do not know what is the best choice for me. When I think about it, I am going to gain weight during this pregnancy and my knee is unstable. What should I do?

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