Suspected inguinal hernias in pregnancy--handle with care!

With a newly described diagnostic pathway, we aim to avoid unnecessary surgical exploration for suspected symptomatic groin hernias in pregnancy.

A consecutive series of eighteen pregnant women was referred to our department due to a gradual onset of inguinal swelling and groin ache. In a prospective clinical study, we evaluated these patients clinically and employed grey-scale and colour Doppler sonography (CDS) in all cases--following a newly described pathway. All patients were examined pre- and post-partum by two qualified surgeons. Median follow-up time was 11 months.

4/18 of the suspected hernias first occurred towards the end of the first, the majority (12/18) in the second, 2/18 in the last trimester and all were suspected after clinical examination only. Most women were referred by their gynaecologists. We found no hernias in any of the women but always noted large varicose veins along the round ligament during CDS. All women gave uncomplicated birth to single children, one by caesarean section. Complaints subsided spontaneously within roughly 2 weeks after delivery. No patient developed a groin hernia until the end of the follow-up period.

The diagnosis of an inguinal hernia with a first symptomatic onset during pregnancy may be wrong in most cases. Anamnesis and clinical examination must be backed by CDS and round ligament varicosity as an important differential diagnosis must always be considered. Our structured diagnostic pathway helps to easily make the correct diagnosis. Surgical exploration of the groin during pregnancy must be avoided.