Dermatologic surgery and the pregnant patient

Area of Science:

• Dermatology
• Obstetrics
• Anesthesiology
• Pharmacology

Background:

• Dermatologic surgeons often avoid cutaneous surgery in pregnant patients due to safety concerns for mother and fetus.
• Pregnancy involves significant physiological changes impacting surgical risk and drug metabolism.
• Hesitancy in performing procedures can delay necessary dermatologic treatment for expectant mothers.

Purpose of the Study:

• To review physiological changes during pregnancy relevant to dermatologic surgery.
• To outline appropriate preparation, procedural timing, and drug safety guidelines for pregnant patients.
• To provide evidence-based recommendations for performing cutaneous surgery during pregnancy.

Main Methods:

• A comprehensive literature review was conducted.
• Searched dermatologic and non-dermatologic journals.
• Focused on studies discussing pregnancy physiology, surgical considerations, and medication safety.

Main Results:

• Specialized patient positioning is necessary during surgical procedures.
• Low-dose local anesthetics with epinephrine and nitrous oxide (<50%) are generally safe.
• Avoid sedatives and opioids due to teratogenic potential; safe antibiotics include penicillins, cephalosporins, and non-estolate erythromycin.
• Lymph node dissection for melanoma in pregnant patients, if required, should be scheduled for the second trimester.

Conclusions:

• Cutaneous surgery can be performed safely and successfully in pregnant patients.
• Appropriate preparation and adherence to safety guidelines are crucial.
• This review provides a framework for managing dermatologic surgical needs during pregnancy.