Effects of Surgery on Pregnant Woman

Just like any surgical procedure, cesarean birth also has its systemic effects. The responses made by the body must be observed by the health care providers carefully so that they could detect any abnormality and provide prompt intervention.

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Body Defenses

  • The primary line of defense that serves as barrier against bacterial invasion is the skin.
  • The moment the skin is incised during surgery, this important line of defense is lost.
  • Since the primary defense has been impaired, strict aseptic technique must be observed.
  • The woman’s risk for infection is greater if cesarean is performed hours after the membranes have ruptured.
  • If the membranes are intact, the physician may prescribe prophylactic antibiotics such as ampicillin or cephalosporin to ensure protection against postsurgical endometritis.

Body Organ Function

  • The body’s normal functions can be disrupted once a body organ is handled, damaged, or repaired in surgery.
  • When there is edema or inflammation, the body organ is impaired further, as well as the surrounding organs.
  • Compresses blood vessels because of edema can affect the distant organs because they can be deprived of blood flow, leading to reduced function in those organs.
  • The uterus may not contract well after surgery because it was handled, and this could lead to postpartum hemorrhage.
  • The bladder will be displaced so that the surgeon can reach the uterus and as a result, the bladder could not sense filling after the procedure.
  • Paralytic ileus or halting of intestinal function may also occur because pressure is also felt by the intestines during surgery.
  • Thrombophlebitis is also possible because of impaired lower extremity blood flow.

Circulatory Function

  • There is always blood loss during surgery, even though vessels that must be cut for surgery are immediately clamped and ligated.
  • Excessive blood loss can lead to hypovolemia and low blood pressure and this could lead to ineffective perfusion of all body tissues.
  • In a vaginal birth, the woman loses 300 to 500 mL of blood, while in a cesarean birth approximately 500 to 1000 mL of blood is lost.
  • The amount of blood lost during cesarean birth is higher because pelvic vessels are congested with blood waiting to supply the placenta.

Stress Response

  • The body has its own way to respond to stressors either physical or psychosocial to preserve the functions of the body.
  • Stress causes the release of epinephrine and norepinephrine from the adrenal medulla.
  • Epinephrine causes an increase in heart rate, bronchial dilation, elevated blood glucose level, peripheral vasoconstriction, and increase in blood pressure.
  • These responses can antagonize anesthetic reaction which is aimed at minimizing body activity.
  • This may also minimize the pregnant woman’s blood supply to the lower extremities.
  • The woman is already prone to thrombophlebitis because of the stasis of blood flow, so these can increase the risk of thrombophlebitis.

Self-Esteem

  • There is always an incisional scar left by surgery afterward.
  • Fortunately, the scar caused by cesarean birth is not overly noticeable because it is made horizontally across the lower abdomen.
  • A woman may still feel a loss of self-esteem if she believes that it marks her as a woman less than others because she was unable to give vaginal birth.

The effects of surgery on a pregnant woman can be a lot to take in, but there are always the health care providers who will guide and teach them every step of the way. The aim of health care providers is to provide safety and comfort for post-surgery patients, especially pregnant women who gave birth via cesarean section, so that their birth experience would be as wonderful as a vaginal birth.

Practice Quiz: Effects of Surgery on Pregnant Woman


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1. A pregnant woman is concerned that she may lose an excessive amount of blood with cesarean surgery. What is the usual amount of blood lost with cesarean birth?

A. 250-350 mL
B. 300-500 mL
C. 500-1000 mL
D. 100-220 mL

2. The physician prescribed a prophylaxis against infection. Which of the following is recommended?

A. Cephalosporins
B. Macrolides
C. Sulfonamides
D. Proton-pump inhibitors (PPI)

3. Pressure is felt by the intestines during surgery, which could lead to:

A. Hyperacidity
B. Paralytic ileus
C. Crohn’s disease
D. Thrombophlebitis

4. What is the best nursing diagnosis for a pregnant woman who lost a lot of blood during cesarean birth?

A. Fear
B. Ineffective coping
C. Ineffective tissue perfusion
D. Activity intolerance

5. Which hormones are released when a woman feels stress?

A. Estrogen and oxytocin
B. Norepinephrine and epinephrine
C. Progesterone and estrogen
D. Estrogen and epinephrine

Answers and Rationale


1. Answer: C. 500-1000 mL

  • C: The average blood loss during cesarean birth is 500-1000 mL.
  • A: 250-350 mL is less than the average blood loss during cesarean birth.
  • B: 300-500 mL is the average blood loss during vaginal birth.
  • D: 100-220 mL is less than the average blood loss during cesarean birth.

2. Answer: A. Cephalosporins

  • A: Cephalosporin is the drug of choice that would be prescribed by the physician as prophylaxis against infection.
  • B: Macrolides are antibiotics but it is not the drug of choice for infection in women who underwent cesarean surgery.
  • C: Sulfonamides are not the drug of choice for infection in women who underwent cesarean birth.
  • D: PPIs are recommended against hyperacidity and are not an antibiotic.

3. Answer: B. Paralytic ileus

  • B: Paralytic ileus results from the pressure felt by the intestines during surgery.
  • A: Hyperacidity is not a complication post-cesarean surgery.
  • C: Crohn’s disease is a condition felt at the gastrointestinal tract but does not result from pressure on the intestines.
  • D: Thrombophlebitis occurs when there is impaired lower extremity blood flow.

4. Answer: C. Ineffective tissue perfusion

  • C: Ineffective tissue perfusion occurs when there is not enough blood for the body organs due to extreme blood loss.
  • A: Fear can be used as the nursing diagnosis before the start of the surgery because the woman may fear the outcome of the surgery.
  • B: Ineffective coping may occur postoperatively when the woman could not perform deep breathing exercises or ambulation due to the pain that she is feeling on the incision site.
  • D: Activity intolerance may occur after surgery due to the postoperative pain that the woman feels at the incision site.

5. Answer: B. Norepinephrine and epinephrine

  • B: Norepinephrine and epinephrine are released by the adrenal medulla when stress is felt.
  • A: Estrogen is already present in a pregnant woman’s body and oxytocin should be administered after birth.
  • C: Progesterone and estrogen are not released when stress occurs.
  • D: Epinephrine but not estrogen is released whenever the woman feels stress.

 

Effects of Surgery on Pregnant Woman

Effects of Surgery on Pregnant Woman.Just like any surgical procedure, cesarean birth also has its systemic effects. The responses made by the body must be observed by the health care providers carefully so that they could detect any abnormality and provide prompt intervention.

Pregnancy and Surgery: What You Need To Know

The decision to have surgery while pregnant can be a difficult one and is often made out of necessity rather than desire. There are two patients to consider (or even more if the person is pregnant with multiples). In general, surgical risks are greater when a patient is pregnant because of the changes that take place in the body during that time.

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There are some cases when surgery can be avoided if a patient is pregnant, but this is not always the case. In fact, certain surgeries (such as a C-section) are often part of pregnancy. Here’s what you need to know about surgery and pregnancy.

Surgery during Pregnancy

In most cases, surgery during pregnancy is avoided whenever possible. This is done both to minimize complications for the pregnant person and the fetus. When a decision is made to perform surgery on a pregnant person, it is typically because their life is in danger.

For example, if a pregnant person develops appendicitis, surgery will be performed to remove the infected organ because the risks of a ruptured appendix outweigh the risks of having an appendectomy.

By contrast, a rhinoplasty (nose job) would not be performed. Elective procedures, such as plastic surgery, are not performed during pregnancy.

Most hospitals perform a pregnancy test on all women of childbearing age immediately prior to surgery to prevent the possibility of surgery on a woman who is unaware of her pregnancy.

Certain procedures may or may not be performed. For example, a procedure to remove a painful, inflamed gallbladder might be performed, depending on the severity of the condition and the general health of the pregnant person and the fetus.

A human fetus is most susceptible to harm caused by exposure to medications during the first trimester—specifically, the first eight weeks of pregnancy. Surgery during this time is usually avoided. If it must be done, surgeons will try to postpone a procedure until the second trimester to reduce the risks.

Your Pregnancy Week by Week

Why it’s avoided

There are multiple reasons why surgery is avoided during pregnancy. One reason is that a pregnant person is hypercoagulable—a medical term meaning their blood is more likely to clot than is typical outside of pregnancy. This change in clotting helps prevent a pregnant person from bleeding too much during childbirth. However, it quintuples the risk of experiencing a blood clot during or after surgery.

For a pregnant person who is 20 weeks or more into their pregnancy, a complication called aortocaval and venocaval compression can also be an issue. This happens when a pregnant person is positioned lying on their back and the weight of the fetus restricts blood flow through major blood vessels. To avoid this, alternative positions that keep a pregnant patient from being flat on their back are used when possible.

10 Tips for Better Sleep during Pregnancy

In addition, when general anesthesia is given to a pregnant person, the fetus also receives the anesthesia. Regional or local anesthesia is used instead of general anesthesia when possible.

C-Sections

A C-section (Caesarean section) is commonly performed on a pregnant person and is considered safe for both the patient and fetus. However, surgeries other than the C-section are typically scheduled for 6 to 8 weeks after delivery.

One exception is a tubal ligation procedure. According to the American College of Obstetricians and Gynecologists (ACOG), this form of postpartum sterilization can be performed as soon as a few hours to days after delivery.1

For a vaginal delivery, postpartum sterilization procedures are usually done the next day. For a C-section, the procedure can often be done immediately after the baby is born.

Considerations

Before having surgery while pregnant, there are multiple things to consider. Here are some questions that medical professionals and patients can ask to clarify the risks of performing a surgical procedure on a person who is pregnant.

  • Can medications before, during, and after the procedure be minimized to decrease risk?
  • Can surgery be delayed until the second trimester to minimize risk to the fetus?
  • Can the risks of anesthesia be decreased by having local anesthesia instead of general anesthesia?
  • Can the surgery be delayed until after childbirth without harming the pregnant patient or the fetus?
  • Do the risks of the procedure outweigh the rewards of the procedure?
  • Is the surgery absolutely necessary?
  • What are the risks of not having surgery?
  • Will the baby survive the procedure?
  • Will the baby survive without surgery?
  • Will the pregnant patient survive without surgery?

Prevention

There is always a risk that a woman of childbearing age might be pregnant when undergoing surgery. If you are you are sexually active and need to have surgery, you will need to have a pregnancy test before the procedure.

In most facilities, a pregnancy test is part of routine testing before a procedure; however, you can request a pregnancy test be done if it is not a standard part of pre-op patient care.

A Word from Very well

It is always advisable to avoid surgery during pregnancy when possible, but many procedures performed on people who are pregnant are successful.

Surgery during pregnancy is not an ideal situation, as it typically means that a person who is pregnant is experiencing a serious, even life-threatening, health issue. That said, if the right precautions are taken it is possible to have a good surgical outcome for both a pregnant patient and a fetus.

Body Defenses

  • The primary line of defense that serves as barrier against bacterial invasion is the skin.
  • The moment the skin is incised during surgery, this important line of defense is lost.
  • Since the primary defense has been impaired, strict aseptic technique must be observed.
  • The woman’s risk for infection is greater if cesarean is performed hours after the membranes have ruptured.
  • If the membranes are intact, the physician may prescribe prophylactic antibiotics such as ampicillin or cephalosporin to ensure protection against postsurgical endometritis.

Body Organ Function

  • The body’s normal functions can be disrupted once a body organ is handled, damaged, or repaired in surgery.
  • When there is edema or inflammation, the body organ is impaired further, as well as the surrounding organs.
  • Compresses blood vessels because of edema can affect the distant organs because they can be deprived of blood flow, leading to reduced function in those organs.
  • The uterus may not contract well after surgery because it was handled, and this could lead to postpartum hemorrhage.
  • The bladder will be displaced so that the surgeon can reach the uterus and as a result, the bladder could not sense filling after the procedure.
  • Paralytic ileus or halting of intestinal function may also occur because pressure is also felt by the intestines during surgery.
  • Thrombophlebitis is also possible because of impaired lower extremity blood flow.

Circulatory Function

  • There is always blood loss during surgery, even though vessels that must be cut for surgery are immediately clamped and ligated.
  • Excessive blood loss can lead to hypovolemia and low blood pressure and this could lead to ineffective perfusion of all body tissues.
  • In a vaginal birth, the woman loses 300 to 500 mL of blood, while in a cesarean birth approximately 500 to 1000 mL of blood is lost.
  • The amount of blood lost during cesarean birth is higher because pelvic vessels are congested with blood waiting to supply the placenta.

Stress Response

  • The body has its own way to respond to stressors either physical or psychosocial to preserve the functions of the body.
  • Stress causes the release of epinephrine and norepinephrine from the adrenal medulla.
  • Epinephrine causes an increase in heart rate, bronchial dilation, elevated blood glucose level, peripheral vasoconstriction, and increase in blood pressure.
  • These responses can antagonize anesthetic reaction which is aimed at minimizing body activity.
  • This may also minimize the pregnant woman’s blood supply to the lower extremities.
  • The woman is already prone to thrombophlebitis because of the stasis of blood flow, so these can increase the risk of thrombophlebitis.

Self-Esteem

  • There is always an incisional scar left by surgery afterward.
  • Fortunately, the scar caused by cesarean birth is not overly noticeable because it is made horizontally across the lower abdomen.
  • A woman may still feel a loss of self-esteem if she believes that it marks her as a woman less than others because she was unable to give vaginal birth.

The effects of surgery on a pregnant woman can be a lot to take in, but there are always the health care providers who will guide and teach them every step of the way. The aim of health care providers is to provide safety and comfort for post-surgery patients, especially pregnant women who gave birth via cesarean section, so that their birth experience would be as wonderful as a vaginal birth.

Practice Quiz: Effects of Surgery on Pregnant Woman


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Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. No time limit for this exam.

Practice Quiz: Effects of Surgery on Pregnant Woman

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Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Be sure to grab a pen and paper to write down your answers.

1. A pregnant woman is concerned that she may lose an excessive amount of blood with cesarean surgery. What is the usual amount of blood lost with cesarean birth?

A. 250-350 mL
B. 300-500 mL
C. 500-1000 mL
D. 100-220 mL

2. The physician prescribed a prophylaxis against infection. Which of the following is recommended?

A. Cephalosporins
B. Macrolides
C. Sulfonamides
D. Proton-pump inhibitors (PPI)

3. Pressure is felt by the intestines during surgery, which could lead to:

A. Hyperacidity
B. Paralytic ileus
C. Crohn’s disease
D. Thrombophlebitis

4. What is the best nursing diagnosis for a pregnant woman who lost a lot of blood during cesarean birth?

A. Fear
B. Ineffective coping
C. Ineffective tissue perfusion
D. Activity intolerance

5. Which hormones are released when a woman feels stress?

A. Estrogen and oxytocin
B. Norepinephrine and epinephrine
C. Progesterone and estrogen
D. Estrogen and epinephrine

Answers and Rationale


1. Answer: C. 500-1000 mL

  • C: The average blood loss during cesarean birth is 500-1000 mL.
  • A: 250-350 mL is less than the average blood loss during cesarean birth.
  • B: 300-500 mL is the average blood loss during vaginal birth.
  • D: 100-220 mL is less than the average blood loss during cesarean birth.

2. Answer: A. Cephalosporins

  • A: Cephalosporin is the drug of choice that would be prescribed by the physician as prophylaxis against infection.
  • B: Macrolides are antibiotics but it is not the drug of choice for infection in women who underwent cesarean surgery.
  • C: Sulfonamides are not the drug of choice for infection in women who underwent cesarean birth.
  • D: PPIs are recommended against hyperacidity and are not an antibiotic.

3. Answer: B. Paralytic ileus

  • B: Paralytic ileus results from the pressure felt by the intestines during surgery.
  • A: Hyperacidity is not a complication post-cesarean surgery.
  • C: Crohn’s disease is a condition felt at the gastrointestinal tract but does not result from pressure on the intestines.
  • D: Thrombophlebitis occurs when there is impaired lower extremity blood flow.

4. Answer: C. Ineffective tissue perfusion

  • C: Ineffective tissue perfusion occurs when there is not enough blood for the body organs due to extreme blood loss.
  • A: Fear can be used as the nursing diagnosis before the start of the surgery because the woman may fear the outcome of the surgery.
  • B: Ineffective coping may occur postoperatively when the woman could not perform deep breathing exercises or ambulation due to the pain that she is feeling on the incision site.
  • D: Activity intolerance may occur after surgery due to the postoperative pain that the woman feels at the incision site.

5. Answer: B. Norepinephrine and epinephrine

  • B: Norepinephrine and epinephrine are released by the adrenal medulla when stress is felt.
  • A: Estrogen is already present in a pregnant woman’s body and oxytocin should be administered after birth.
  • C: Progesterone and estrogen are not released when stress occurs.
  • D: Epinephrine but not estrogen is released whenever the woman feels stress.