Management of general surgical emergencies in pregnancy

The management of 25 pregnant patients (gestational age 4-40 weeks) treated at Henry Ford Hospital from 1980-86 was reviewed. Eleven women were treated for a variety of nontraumatic general surgical emergencies including cholecystitis, appendicitis, pancreatitis, and gastrointestinal obstruction. Fourteen women were treated after sustaining traumatic injuries. Ten patients were managed without operation and 15 required surgical intervention as part of their treatment. Diagnostic studies that proved helpful included diagnostic peritoneal lavage, ultrasonography, intravenous pyelography, and roentgenograms of the chest and abdomen. There were no maternal deaths, but two fetal deaths occurred as a result of traumatic injuries. Five women and one neonate developed major complications requiring prolonged hospitalization. Early aggressive resuscitation and thorough diagnostic evaluation are required to achieve a favorable outcome in the management of the pregnant patient who presents with an emergent general surgical problem.