Gastrointestinal endoscopy in the pregnant woman

Table 1 Unique features of endoscopy during pregnancy

1 Two or more patients at risk

2 Medications and anesthesia usually used may be contraindicated due to fetal risks

3 Patient position an issue in terms of placental blood flow

4 Greater concerns for blood pressure fluctuations due to concerns about placental perfusion

5 Greater concern for aspiration in later pregnancy

6 Disease states that may be exacerbated by pregnancy (GERD) or specific to pregnancy (hyperemesis gravidarum, gestational diabetes, third trimester liver syndromes-HELLP syndrome, etc.)

7 Deferral of procedure to more optimal times (e.g., defer procedure from second trimester to postpartum, with possible expedited delivery)

8 Duration of procedure prime concern

9 Obstetric input and monitoring usually necessary

10 Screening for malignancy and Barrett’s esophagus less of a concern

11 Avoidance of radiation-based and interventional ancillary procedures (computed tomography imaging, angiography)

12 Monopolar electrocautery (e.g., with sphincterotomy) may harm fetus

GERD: Gastroesophageal reflux disease.