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Endoscopy during pregnancy when necessary in Dhakuria

Endoscopy during pregnancy when necessary

Endoscopy During Pregnancy in Dhakuria, West Bengal

Pregnancy is a challenging period for both the mother and her child. Extensive medical procedures are discouraged. However, there can be situations where undergoing Endoscopic procedures is deemed necessary for optimal health during pregnancy. 

Some of the medical conditions during pregnancy that require Endoscopy are:

  • Severe bleeding from the gastrointestinal tract

  • Unexplained and recurrent abdominal pain

  • Severe reflux that cannot be controlled with medications

  • Dysphagia

  • When a pregnant woman has severe nausea or vomiting

  • When there is a strong suspicion of colon mass

According to studies, not undergoing Endoscopic procedures when intended can expose the mother and foetus to further complications. However, the procedure itself carries some risks that can be detrimental to the health of the foetus and even cause death. Therefore, Endoscopy is suggested only when necessary or when the benefits outweigh the risks.

Our expert obstetricians and gynaecologists at Manipal Hospitals in Dhakuria, West Bengal, frequently monitor the health status of all pregnant women. They may recommend Endoscopic procedures only when necessary. Our hospital boasts the latest and most sophisticated equipment that enables our doctors to perform Endoscopic procedures with minimal complications on pregnant women.
 

FAQ's

A long, thin tube is inserted straight into the body during an Endoscopy to view an internal organ, such as the gastrointestinal tract, in great detail. In addition, doctors can use it for other instances like surgery and imaging. Endoscopies, which involve bodily openings like the mouth or anus, are minimally invasive procedures.

Depending on the indications, the following Endoscopic procedures can be performed during pregnancy:

  • Upper Gastrointestinal Endoscopy

  • Percutaneous Endoscopic Gastrostomy

  • Sigmoidoscopy

  • Colonoscopy

  • Endoscopic Retrograde Cholangiopancreatography

  • Endoscopic Ultrasonography

These Endoscopic procedures must be performed only by endoscopists under the strict supervision of obstetricians or gynaecologists. 
 

Your healthcare provider follows the following steps:

  • Consultation: To determine whether an Endoscopy is necessary during pregnancy, the patient meets with her gastroenterologist and obstetrician.
  • Risk Assessment: Considering the stage of pregnancy and the ailment that requires medical attention, the advantages and risks of Endoscopy are assessed.
  • Informed Consent: The patient gives their consent after being made aware of the procedure's advantages and disadvantages.
  • Foetal Monitoring: To guarantee the health of the unborn child, Foetal Monitoring may be carried out continuously throughout the process.
  • Sedation: Options for sedation are carefully selected to ensure patient comfort and reduce dangers to the foetus.
  • Procedure: A qualified gastroenterologist uses the right tools and methods to perform the Endoscopy.
  • Post-procedure Monitoring: The foetus's health is given extra consideration as the patient is closely monitored for any issues or unfavourable reactions. 
  • Follow-up: The patient may need to schedule follow-up appointments to track their progress after receiving post-operative care instructions following the operation.

For sedation during pregnancy, propofol is considered to be safer during the second and third trimesters of pregnancy. In rare instances, meperidine and midazolam may also be used safely for Endoscopic procedures during pregnancy. If Endoscopy cannot be deferred in the first trimester, propofol may be used after careful consideration.
 

Endoscopy during pregnancy may be necessary for several reasons, such as the assessment of:

  • Gastrointestinal symptoms that do not improve with conservative treatment
  • Unexplained abdominal pain 
  • Recurrent gastrointestinal bleeding
  • Suspected gastrointestinal obstruction

Furthermore, it can be required for the identification and treatment of illnesses such as gastroesophageal reflux disease, gastrointestinal tumours, and inflammatory bowel disease, which carry a high risk of harm to the health of both the mother and the foetus if left untreated. Nonetheless, Endoscopic operations are usually saved for situations in which the advantages outweigh the possible hazards, with careful attention being given to the condition's urgency, gestational age, and potential effects on the health of the mother and foetus. 

Women suffering from severe vomiting and dehydration may require hospitalisation and parenteral nutrition. If parenteral nutrition is to be given for a long time, then Percutaneous Endoscopic Gastrostomy (PEG) is employed. The placement of a PEG tube may be restricted due to the risks of uterine damage, premature labour and infection, and foetal injury.
 

Endoscopy in pregnancy is contraindicated when:

  • Unstable maternal condition or serious medical illness at advanced gestational age, especially in the third trimester.
  • High-risk pregnancy with complications like placenta previa or placental abruption
  • Known foetal abnormalities or congenital anomalies.
  • Lack of a clear clinical indication for the Endoscopic procedure.
  • Incapacity to sufficiently monitor the health of the mother and foetus throughout the treatment.
  • Dangers of sedation or anaesthesia beyond possible advantages.
  • The presence of less hazardous alternatives for diagnosis or treatment could affect the health of the mother and foetus.
  • There is a shortage of qualified medical personnel to carry out the operation safely.

Endoscopic Ultrasonography helps diagnose gastrointestinal and pancreaticobiliary disorders. The diagnostic procedure helps prevent unnecessary interventions in patients with low to moderate choledocholithiasis. The procedure is relatively safer than ERCP and is preferred for diagnosing gastrointestinal disorders in pregnant women.
 

Risks related to the Endoscopic process and its impact on the foetus exist while doing an Endoscopy during pregnancy. Among these dangers are:

  • Premature labour: During the process, manipulation of the uterus may cause contractions, which could result in early labour.
  • Foetal distress: Modifications in the mother's blood pressure, oxygen saturation, or the way anaesthesia is administered may have an impact on the foetus's health and may result in foetal misery.
  • Uterine perforation: During the procedure, there is a small chance of uterine perforation, which could result in bleeding or infection.
  • Complications from anaesthesia: There are dangers associated with administering anaesthesia, such as respiratory depression and allergic reactions, which can have an impact on the foetus as well as the mother.
  • Infection: Endoscopy carries the danger of infection, which may result in issues for both the mother and child.
  • Miscarriage: Endoscopy carries a small but possible risk of miscarriage, especially if the woman experiences severe stress or trauma during the procedure.
  • Radiation exposure: The foetus may be exposed to radiation during the process if imaging methods like Fluoroscopy are employed. This could hurt the fetus's development.

Consultation with a gastroenterologist and obstetrician is necessary before undergoing an Endoscopic procedure. The medical experts will guide the best approach, considering the health of the mother and the child. You might have to fast for a specific period before undergoing the procedure. Talk about the medication you take with your doctor. Have someone accompany you, as you may feel groggy post-procedure.
 

The risks of problems or adverse effects increase during the first trimester since your baby is still developing and forming important organs. Furthermore, sedation is not recommended during the third trimester due to the possibility of excessive discomfort and the possibility of early labour.

The safety of GI Endoscopy during pregnancy is not well studied. However, the procedure is recommended when there is a strong indication. When the decision for Endoscopy is made, the doctor takes informed consent and explains the associated risks to the foetus and the mother.
 

Before undergoing the Endoscopic procedure, the obstetrician must carry out a thorough assessment of the mother and foetus’s health. 

  • The procedure is undertaken only when necessary or for high-risk pregnancies. 

  • If possible, the procedure must be delayed until the second trimester

  • The lowest dose of sedative medication is recommended

  • Reduce the duration of the procedure

  • Position the patient in left pelvic tilt or left lateral compression to prevent inferior vena cava compression

  • Before 24 weeks of gestation, the foetal heart rate is monitored with Doppler before and after an Endoscopic procedure

  • After 24 weeks of gestation, the foetal heart rate is monitored throughout the procedure. However, uterine contractions must be monitored before and after the procedure.

Some of the potential risks include:

  • The foetus is sensitive to maternal hypoxia (low oxygen supply) or hypotension (low blood pressure), either of which can cause foetal death.

  • Oversedation of the mother can cause hypotension or hypoventilation.

  • Incorrect positioning of the mother can cause inferior vena cava compression, resulting in decreased uterine blood flow and foetal hypoxia.

  • Medication given to the mother during the procedure can have a teratogenic effect on the foetus.

  • Premature birth.

However, this procedure is considered relatively safe in comparison to radiologic or surgical interventions. Our expert doctors are adept at performing Endoscopic procedures with minimal complications for the mother and the child.

ERCP is a challenging procedure to perform. The patient is made to lie in a prone position for a significant period. As a result, there is an increased need for anaesthetic medication and a heightened risk of placental perfusion. Additionally, when Fluoroscopy is used, there is a chance of radiation exposure to the foetus. Therefore, it's evident that the complications associated with ERCP are greater in comparison to other Endoscopic procedures.
 

Endoscopy procedures are contraindicated in cases of placental abruption, ruptured membranes, uncontrolled eclampsia, or the possibility of delivery due to the procedure.
 

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