Dermatologic Surgery and the Pregnant Patient

Abstract

background. Because of concerns about potential harm to the mother or fetus, dermatologic surgeons are frequently hesitant to perform cutaneous surgery on pregnant patients. objective. To review the relevant physiologic changes during pregnancy, appropriate preparation for and timing of procedures, and drug safety. methods. A literature review was performed of dermatologic and nondermatologic journals discussing physiology, surgery, and drug safety in the pregnant patient. results. Special positioning is required for the pregnant patient during surgery. Low doses of most local anesthetics with epinephrine as well as nitrous oxide less than 50% are safe to use during pregnancy. Sedatives and opioids are potential teratogens and should be avoided. Safe antibiotics to use during skin surgery in pregnancy include penicillins, cephalosporins, and nonestolate erythromycin. If necessary, lymph node dissections under general anesthesia in the pregnant melanoma patient should occur during the second trimester. conclusion. With appropriate preparation, safe and successful cutaneous surgery can be performed on the pregnant patient. Respiratory ChangesBy term, there is an increase in tidal volume and minute respiration to 30-40% due to increased fetal K.A. Richards, MD and T. Stasko, MD have indicated no significant interest with commercial supporters.

Safety of Cosmetic Dermatologic Procedures During Pregnancy

“…Blood pressure tends to decrease toward the end of the first trimester of pregnancy, with physiologic hypotension most likely to be present between weeks 14 and 24. By the third trimester, blood pressure typically returns to the woman's normal prepregnancy level …”

“…The gravid uterus can cause compression of venous blood return to the heart. Therefore, the safest surgical position is upright or in the left lateral decubitus position . These positions allow for maximal venous return to the heart …”

Dermatologic surgery and cosmetic procedures during pregnancy and the post-partum period

“…Patient positioning is important to the operating physician to allow the best access to the surgical site. However, in the situation of the pregnant patient, care must be taken to prevent compression of the inferior vena cava, leading to hypotension and the related symptoms of headache, nausea, vomiting, diaphoresis and tachycardia . The preferred position is that of a left lateral tilt with the addition of a wedge or pillow under the right hip or between the knees.…”

“…There may be ligament laxity that is secondary to hormonal changes. This laxity may lead to muscle cramps or low back pain and will usually be relieved with shifting position with or without further pillow support.…”

Use of Short-Acting Local Anesthetics in Hand Surgery Patients

“…Of these, lidocaine falls within the Food and Drug Administration "use-in-pregnancy" category B, and epinephrine and bupivacaine fall within category C (Table 1). 3 All these agents cross the placenta. Despite a lack of adequate studies in pregnant women, lidocaine is felt to be safe for administration during pregnancy when used with strict adherence to safe practices (calculating the maximum allowable dosage before administration, checking the concentration as well as the presence or absence of potent vasoconstrictor agents on the vial, and avoiding intravascular administration by aspiration before injection).…”