Optimizing maternal health before surgery is crucial to improving both maternal and fetal outcomes. This involves managing any coexisting medical conditions effectively. For instance, hypertensive disorders in pregnancy, such as chronic hypertension or preeclampsia, require close monitoring and possibly the use of antihypertensive medications to maintain blood pressure within a safe range. Conditions like gestational diabetes should be tightly controlled with diet, oral hypoglycemic agents, or insulin to prevent perioperative hyperglycemia, which can increase the risk of infection and delay wound healing. Respiratory conditions, such as asthma, may require optimization of pulmonary function through bronchodilators and inhaled corticosteroids to reduce the risk of perioperative respiratory complications.
Nutritional status is another important factor to consider. Pregnant patients, especially those with hyperemesis gravidarum or other conditions affecting intake, may be at risk for malnutrition or electrolyte imbalances. Preoperative nutritional optimization includes ensuring adequate caloric and protein intake and correcting any deficiencies in micronutrients such as iron, calcium, and folate. Anemia, which is common in pregnancy due to increased iron requirements, should be identified and treated with iron supplementation or, in severe cases, blood transfusion, to improve oxygen-carrying capacity and reduce the risk of perioperative complications.
Thromboprophylaxis is a vital part of preoperative preparation due to the hypercoagulable state of pregnancy. Mechanical prophylaxis, such as graduated compression stockings or intermittent pneumatic compression devices, is recommended for all pregnant patients undergoing surgery. For those at higher risk of thromboembolism, such as patients with a history of deep vein thrombosis, inherited thrombophilia, or obesity, pharmacologic thromboprophylaxis with low molecular weight heparin (LMWH) may be indicated. The timing of LMWH administration should be carefully planned to balance the risk of bleeding with the risk of thromboembolism.
| Area | Strategy |
|---|---|
| Hypertensive disorders | Chronic hypertension and preeclampsia need close monitoring and possibly antihypertensive medication to keep blood pressure in a safe range |
| Gestational diabetes | Tight control with diet, oral hypoglycemic agents or insulin to prevent perioperative hyperglycemia, which raises infection risk and delays wound healing |
| Respiratory conditions | Optimize pulmonary function in conditions such as asthma with bronchodilators and inhaled corticosteroids |
| Nutrition | Ensure adequate caloric and protein intake and correct deficiencies in iron, calcium and folate, especially with hyperemesis gravidarum or other conditions affecting intake |
| Anemia | Common in pregnancy from increased iron requirements; treat with iron supplementation or, in severe cases, blood transfusion |
| Mechanical thromboprophylaxis | Graduated compression stockings or intermittent pneumatic compression devices are recommended for all pregnant patients undergoing surgery |
| Pharmacologic thromboprophylaxis | Low molecular weight heparin may be indicated for higher-risk patients — prior deep vein thrombosis, inherited thrombophilia or obesity — with timing planned to balance bleeding against thromboembolism |
