Savas N. Gastrointestinal endoscopy in pregnancy. World J Gastroenterol 2014; 20(41): 15241-15252 [PMID: 25386072 DOI: 10.3748/wjg.v20.i41.15241]
Corresponding Author of This Article
Dr. Nurten Savas, Department of Gastroenterology, Baskent Universitesi Hastanesi, Oymacı Sokak No. 7, Altunizade, 06990 Istanbul, Turkey. nakyurek2000@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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World J Gastroenterol. Nov 7, 2014; 20(41): 15241-15252 Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15241
Table 1 General principles for endoscopy in pregnant women1
1
Always have a strong indication, particularly in high-risk pregnancies
2
Endoscopy should be postponed to second trimester whenever possible
3
Lowest effective dose of sedative medications should be used
4
Especially category A or B drugs should be used
5
Procedure time should be very short
6
To avoid vena caval or aortic compression, pregnant women should be positioned in the left pelvic tilt or left lateral position
7
Fetal heartbeat should be detected before sedation and also after the endoscopic procedure
8
Obstetric support should be available whenever pregnancy-related complications occur
9
Placental abruption, imminent delivery, ruptured membranes, or eclampsia are defined as obstetric complications of endoscopy
Table 2 United States food and drug administration categorization of drug safety during pregnancy1
Category
Risk
Description
A
No risk has been shown in controlled studies
Sufficient, well-controlled studies have not demonstrated a risk to the fetus in any trimester of pregnancy
B
No risk in humans
Sufficient, well-controlled studies have not demonstrated an increased risk of fetal abnormalities despite adverse findings in animals or, in the absence of adequate human studies, animal studies show no fetal risk. The chance of fetal harm is very low but still is a possibility
C
Risk cannot be ruled out
Sufficient, no well-controlled human studies, where animal studies have shown a risk to the fetus. There is a chance of fetal harm if the drug is administered during pregnancy, but the potential benefits should be considered and may outweigh the potential risk
D
Positive evidence of risk
Studies in humans, or investigational or postmarketing data, have demonstrated fetal risk. Nevertheless, potential benefits from the use of the drug may outweigh the potential risk. For example, the drug may be acceptable if needed in a life-threatening situation or for serious disease for which safer drugs cannot be used or are ineffective
X
Contraindicated in pregnancy
Studies in animals or humans (investigational or postmarketing reports) have demonstrated positive evidence of fetal abnormalities or risk that clearly outweighs any possible benefit to the patient
Table 3 Safety of anesthetics commonly used in gastrointestinal endoscopy
Drug
FDA category in pregnancy
Key points about drug safety
Narcotics
Meperidine
B, but D at term
Repeated use of high dose and prolonged administration can cause respiratory depression and seizures
Fentanyl
C
It is safe in low doses
Propofol
B
Generally suggested for use in patients who are sedated with difficulty and in complicated clinical situations
General anesthetics
Ketamine
B
Data are limited with humans; animal data suggest prolonged use is not safe
Sedatives
Diazepam
D
Some congenital malformations and mental retardation may be associated with diazepam, the use of diazepam during pregnancy is restricted
Midazolam
D
As a benzodiazepine member, its use is restricted during pregnancy, especially in the first trimester
Reversing agents
Naloxone
B
It probably is safe but should be used only in respiratory depression, systemic hypotension, or unresponsiveness in a closely monitored pregnant woman after endoscopy
Flumazenil
C
Fetal risks are unknown, but it should be given carefully in small doses
Table 4 Indications for endoscopy in pregnancy
No.
Indication
1
Major or continued bleeding
2
Severe or refractory nausea and vomiting or abdominal pain
3
Dysphagia or odynophagia
4
High suspicion of colonic mass
5
Severe diarrhea with negative evaluation
6
Biliary pancreatitis, CBD stones, or cholangitis
7
Biliary or pancreatic ductal injury
Citation: Savas N. Gastrointestinal endoscopy in pregnancy. World J Gastroenterol 2014; 20(41): 15241-15252