As many as 2% of pregnant women undergo anesthesia for non-obstetric surgery. Routine pregnancy testing should be mandatory for all women of child-bearing age. Note that organogenesis occurs from 15-56 days of gestation. Early concerns for the pregnant patient revolve around the potential for altered organogenesis, but as the fetus matures concerns shift towards fetal hypoxia (as metabolic demands increase) and accidental induction of premature labor
A total of five studies have attempted to understand the complex relationship between surgery and anesthesia and pregnancy. Taken as a whole, there does not appear to be a relationship between surgery or anesthesia and congenital abnormalities, but there is a significant relationship between surgery and/or anesthesia and fetal death [Barash, PG. Clinical Anesthesia, 5th ed. (Philadelphia), p. 1176, 2006]. The Duncan study, of 2565 pregnant Canadian women (matched based on age, region, etc.), was notable in that it showed a statistically significant increase in the risk of spontaneous abortion in both the first and second trimesters (from 6.5 to 7.1%) . The Mazze and Kallen study is analyzed 5,405 Swedish births and found no increased incidence of congenital anomalies in children whose mothers had gestational surgery, although they did find an increased incidence of VLBW infants as well as mortality within 168 hours of surgery, both of which the authors postulated might have been due to the illness and not the surgery/anesthesia.
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