QuestionI am 33 years old and am 7-1/2 weeks pregnant with my second baby. I have a 14 month old healthy baby girl. The date of my last menstrual period was 9/27/05. My husband and I had IUI to conceive this baby after 6 months of unsuccessfully trying naturally. FYI, my husband has a motility problem. I was on Gonal-F injectables for the IUI. The night of the IUI, I had my very first gallbladder attack. After a few more attacks over the following week, I finally went into an urgent care center where they diagnosed me with gallbladder disease. An ultrasound showed stones & sludge. I am currently 7-1/2 weeks pregnant; and thus, I've had these gallbladder problems for 5-1/2 weeks now. During the past 5-1/2 weeks, I've had over 6 attacks. Four of the six were severe enough that the pain lasted for 3 days. I visited a surgeon who advised that a stone was stuck in my common duct each time, and that's why I was having so much pain. My liver enzymes were sky-rocketed too. I'm trying to control it with a low-fat, low-cholesterol diet, but I still feel lousy in general. I also had another attack last night after just eating a bowl of cereal. I feel very achy ...chest, back, ribs, etc. today.
I'm getting differing opinions about whether or not to hold off until my second trimester for laporoscopic surgery. My OB/Gyne says that if I need the surgery, I better get it now. She said that the only reason that it's advised to hold off on surgeries until the second trimester is because most natural spontaneous abortions happen during this time. If I had the surgery during my first trimester and a spontaneous abortion happended to occur, they wouldn't want me to think it was due to the surgery. My reproductive endocrinologist stated, however, that miscarriage rates from the surgery are as high as 10% in the first trimester. She definitely advised to hold off until the second trimester if I could help it. The surgeon also agreed that it's better to wait until the second trimester, but because of the severity of my condition, she doesn't think that I can hold out that long.
After all that, I'm so confused. What is the real story? Do the rate of miscarriages DUE TO SURGERY go down after the second trimester? What is the miscarriage rates DUE TO SURGERY during the first & second trimesters? If it's advisable to wait until second trimester for surgery, should I try to wait until 15-16 weeks (until I'm well into my second trimester)? Are there risks of birth defects due to the anesthesia, CO2 that they inflate your stomach with, or ANY element of the surgery? Do the rate of birth defects go down after the first trimester?
Bottom line is that I know I need the surgery soon. I've been feeling lousy in between attacks with stomach aches, dull chest aches, etc. The attacks are getting closer together too. If it's best to hold out for the baby's sake, I certainly will. Your advice is so much appreciated. Thank you in advance!
AnswerThe reason for waiting until after the first trimester to perform the surgery is purely anecdotal. The risk for miscarriage in the first trimester is 15-20% of every pregnancy. There is no risk of congenital or adverse effects to the baby from the anesthesia, CO2 insufflation, or the surgery itself. However, manupulation of the abdominal organs can cause a slight risk of preterm labor or miscarriage. However, if the pain is so intractable and you get attacks with merely a bowl of cereal, I would think that you will be miserable until you have the cholecystectomy. If you could possibly wait 5 more weeks, it probably would be safer. However, if not, I don't think you will have a problem. I have had many patients who had to have the cholecystectomy during the first trimester with no problems. You have to treat this as an urgent problem, like appendicitis or intestinal obstruction.
