Medical procedures during pregnancy: What’s safe and forbidden
In the third trimester, only urgent cases are advised.
What you need to know:
- The general rule is that a clinician must weigh the benefits against the risks because every medical procedure carries some risk.
- When a woman is pregnant, decisions are usually made in a multidisciplinary manner.
Nine months of pregnancy can feel like a lifetime. The first few weeks come with changes. The body then gets used to the changes. As the baby grows in the uterus, the changes become even more apparent. In the process, a mother’s life goes on as usual. They fall sick. They get well. They go to work. But sometimes, medical intervention becomes necessary along the way. We spoke to three specialists about which procedures are safe during pregnancy, and which should be avoided to protect both mother and child. Here is what you need to know.
Are there procedures that can be done and others left out?
The general rule is that a clinician must weigh the benefits against the risks because every medical procedure carries some risk. When a woman is pregnant, decisions are usually made in a multidisciplinary manner.
For example, if a gynaecologist sees a pregnant patient with a toothache, they refer her to a dentist. The dentist will then evaluate the infection. It may be something that can be treated simply with antibiotics. But if the infection poses a danger to the mother's life, the dentist may decide that a procedure is necessary. Dentists are trained to make that judgment.
In other cases, procedures are best avoided until after delivery. Take fibroids, for instance. Doctors may not remove fibroids during pregnancy, no matter how large they are.
This is because pregnancy increases blood circulation in the uterus, and removing a fibroid at this stage could cause the patient to bleed to death. Instead, doctors explore alternative management options and schedule any procedure for at least six weeks after delivery. Even then, circulation and inflammation remain elevated, but the risk is lower.
Can pregnant women have dental procedures? (A gynaecologist's view)
Yes, they can, but with important caveats. The general advice is to avoid elective procedures that are not urgently needed.
In the first trimester, due to the risk of miscarriage and the potential for dental infections to spread to the uterus, clinicians only perform urgent cases. These include tooth abscesses, severe infections, or painful broken teeth.
The second trimester offers a wider window. Elective procedures such as teeth cleaning or even crowning can be considered, though they carry a small risk of infection spread.
Research has shown that periodontitis (gum inflammation) or odontitis (tooth inflammation) can lead to preterm birth, making dental health during pregnancy a priority.
In the third trimester, only urgent cases are advised. Long procedures should be avoided because the enlarged uterus sits on the inferior vena cava, a major blood vessel, when a patient lies back. This can cause a drop in blood pressure (hypotension) and, in severe cases, death. There is also the risk of infection spreading to the uterus, potentially causing severe sepsis.
What procedures can be done during pregnancy?
If a pregnant woman is involved in an accident, she will likely undergo procedures to treat her injuries. Being pregnant does not mean a woman must endure pain.
What happens to a cancer patient who is pregnant?
Every case is handled individually. Doctors assess the level of danger the condition poses to the patient, then make a decision. When a situation falls outside an obstetrician's expertise, clinicians work as a multidisciplinary team to make a decision. If a patient requires cancer medication during pregnancy, oncologists and gynaecologist must ensure the treatment plan protects both mother and baby.
What if a patient insists on having a procedure?
Medical ethics do not require doctors to simply follow a patient's wishes. Before making a decision, a doctor takes full responsibility for assessing the risks involved.
There are times when patients insist on certain procedures such as caesarean sections. In such cases, the doctor advises them on the potential risks. Yielding to patient insistence without medical justification can lead to serious harm or even death.
What should patients do?
Patients should always ask whether there are alternatives. There is almost always an alternative approach. When no alternative exists, that is when doctors carefully weigh the benefits against the risks before proceeding.
Can a pregnant woman have a CT scan?
If it is just an ordinary CT scan, it can be done. For example, if a woman has a brain tumour, a CT scan may be required to diagnose the condition. Similarly, a CT scan may be needed to check for a blood clot that could dislodge and travel to the lungs, a life-threatening condition called pulmonary embolism. A clot can kill if ignored, and in such cases, doctors can comfortably make the decision to proceed.
When no significant risks are present, doctors rarely recommend CT scans for pregnant women. A scan should only be performed if it provides essential information needed to treat the patient or to monitor improvement after treatment.
Can pregnant women undergo cosmetic surgery?
Outrightly, no. A qualified cosmetic surgeon should advise against it. Pregnancy brings significant hormonal changes that alter the body physically. Treating these temporary changes with cosmetic surgery is both dangerous and unnecessary.
From a dentist's point of view, how do you manage pregnant women with tooth problems?
When a woman becomes pregnant, her immunity naturally lowers, making her more prone to infections and inflammation. This means a tooth infection during pregnancy can be more life-threatening than it would be otherwise. That said, it is not wrong for a pregnant woman to visit a dentist; it simply means she needs extra care and awareness that her immunity is reduced.
Dentists also take precautions around positioning. Since it is advisable for pregnant women not to lie on their backs for extended periods, a dentist will ensure the visit is short to avoid straining the mother or the baby.
Can a pregnant woman get a tooth X-ray?
Yes, they can, and this is a myth that needs debunking. Dental X-rays are perfectly safe during pregnancy, especially in the first trimester. If necessary, a dentist can use a lead apron to reduce radiation exposure further.
There is no need for a pregnant woman to endure pain and wait until after delivery. The key is to see an experienced professional who can advise on the safest course of action.
Expertise from Dr Richard Mogeni (obtestrician and gynaecologist) Prof Moses Obimbo (obtestrician and gynaecologist and professor at the University of Nairobi), and Dr Branice Munyasa (oral and maxillofacial surgeon)
