Oh, by the way, the patient is pregnant!

Approximately one to three per cent of pregnant women undergo surgery that is unrelated to their pregnancy. In Canada this represents about 5,000 patients each year that present unique challenges to the perioperative nurse and the entire surgical team. Approximately five to ten per cent of these patients are involved in trauma, which causes 46.3% of maternal deaths. A small percentage of elective procedures are carried out in the first trimester, before the patient herself is aware of the procedure. The majority of procedures are required for urgent and emergent conditions that require surgery despite the risks to the mother and fetus. This article will discuss perioperative care of the non-obstetric pregnant patient and to introduce a nursing care guideline that can be used as a quick-reference tool. The care discussed in the appended Guideline focuses on the pregnant condition and is to be used in conjunction with routine perioperative care practices. Semi-elective and urgent surgery is not contraindicated by pregnancy, although anesthetic and surgical approaches must be modified to promote the safety of mother and her fetus. If possible, the surgery should be postponed to the second trimester. By this time major systems of the fetus are formed and the uterus does not yet infringe on abdominal structures and manipulation may be kept to a minimum. In the first trimester, spontaneous abortion is the greatest risk at 12%. This decreases to less than five per cent in the second and third trimesters. Pre-term labor presents the greatest risk in the second and third trimesters. The most common need for surgery in pregnancy is associated with appendicitis, biliary tract disease, intestinal obstruction, urinary calculi and trauma.