QuestionDr. Rappaport,
You were so kind to quickly respond to my question a few days ago relative to gallbladder surgery and whether or not I should wait until my second trimester for the surgery. I am just 8 weeks pregnant with my second baby, and I'm 33 years old. My last menstrual period was Sept. 27, 2005. As I told you, my attacks are more frequent now and I'm feeling just miserable lately. I have constant stomach aches, diarrhea, frequent belching, and nausea (this may or may not be related to the pregnancy).
I had an attack last Thursday, and I had another attack tonigh...just 3 days later. I had plans on holding off until my second trimester, but I don't know if I can. The attacks are so unpredictable. I've been eating a strict low fat, low cholesterol, bland diet and am still getting these attacks. You suggested that it would be the safest to hold off until my second trimester but if I am not able and the attacks continue, I should have the surgery ASAP. I visited a surgeon today and was so unnerved and disappointed with her answers to some of my basic questions. I asked her what extra precautions she would take during the lap chole due to my pregnancy, such as fetal monitoring, fetal ultrasounds after the surgery, etc. Her response was, "If you lose the baby, there's nothing we can do about it. Most OB/Gynes will agree that fetal monitoring is unnecessary because a fetus under 20 weeks wouldn't survive anyway." This was NOT what I wanted to hear. She said if I lost the baby, there was nothing they could do about it. I realize that, but I wanted her to at least assure me that they would be monitoring the baby throughout the surgery. Maybe she could give me less CO2 insufflation than a non-pregnant patient. Maybe she could have stated that she'd try to coordinate it with my OB/Gyne, etc. to make sure that every precaution was taken. I also read an article on the internet about a lady that was given antibiotics during her lap chole and her baby's teeth came out without enamel. I know I need the surgery, but I'm going to find a more compassionate surgeon. My husband and I worked very had to become pregnant with the help of an RE; so, I didn't exactly find the surgeon's answers reassuring.
Dr. Rappaport, what is the very least I could expect from a general surgeon about precautions they take on a pregnant patient? What are some good questions that I could ask a surgeon about what they would do to minimize the risk of miscarriage (or birth defects)? How do I go about finding a surgeon that has experience in operating on pregnant woman? The web doesn't offer much help. By the way, I live in northern Illinois.
Also, I've been taking 2-4 Vicodins with each attack, and I've had about 7 attacks since I've been pregnant. I've been told that Vicodin is safe from a couple different doctors, but I wanted your opinion as well.
Lastly, I've been reading that surgeries are safest during the second trimester not only because of the risk of miscarriage but also because of teratogenicity associated with first trimester surgeries. Can you give me your opinion on this as well?
Thank you in advance for your help. I greatly appreciate your help and professional opinion.
AnswerThere is no risk of teratogenicity during surgery unless they use medications that are contraindicated during pregnancy. The woman that had a baby that was born without enamel on her teeth was given Tetracycline, which is contraindicated during pregnancy. That is the only medication that will do that and most every doctor knows not to give it. There is no way to monitor a baby until it is older than 23 weeks gestation (from your last period). There are no precautions that should be taken during the surgery. The only risk of having it done in the first trimester is the risk of miscarriage. The miscarriage would not be caused by the surgery, but manipulation of the uterus can lead to preterm labor. I'm sure they will avoid the possibility of infection. The risk of miscarriage is 15-20% of every pregnancy. If you continue to have attacks that you cannot tolerate, I would go ahead with the pregnancy. Your surgeon may have a bit pragmatic, but she was not incorrect. Usually, gall bladder attacks are manifested by right upper quadrant pain. The stomach aches, diarrhea, belching, and nausea may be related to the pregnancy and not due to the gall bladder. Don't worry about the surgery. Millions of women have a laparoscopic cholecystectomy in early pregnancy without any harm to the fetus. If you can tolerate waiting until the second trimester, it may be a little bit safer, but if you cannot tolerate your symptoms, do it now.
