Current Issue June 2012, Vol. 49, No. 6

The surgical care of the pregnant patient continues to represent a significant challenge. Pregnancy not only alters anatomy, requiring different technical approaches, but also has dramatic effects on physiology that require significant alterations in anesthesia, fluid management, and the use of medications. The magnitude of these changes varies through each trimester. In addition, the surgeon really is caring for two patients simultaneously and diagnostic and therapeutic approaches must balance sometimes conflicting risk-benefit considerations for mother and fetus. In this issue of Current Problems in Surgery, Drs. Stephen R.T. Evans, Babak Sarani, Parag Bhanot, and Elizabeth Feldman from the Georgetown University School of Medicine in Washington, DC have written a masterful overview on this topic entitled, “Surgery in Pregnancy.” Dr. Evans brings a unique perspective, having trained first in obstetrics and gynecology before he entered general surgery. They begin with a discussion of the physiological alterations of pregnancy with an emphasis on those considerations critical for the surgical management. Optimal evaluation of the pregnant patient with surgical disease, including the unique radiologic considerations, is then addressed in significant detail. They conclude by addressing the specifics of the most common surgical conditions in the pregnant patient, including abdominal pain and disorders of the small bowel, colon, hepatobiliary tree, pancreas, abdominal wall, breast, thyroid, and adrenal. Unique management considerations after trauma in the pregnant patient are also outlined. This superb review should become a valued addition to the literature on this complex topic and a resource for all caregivers involved in the care of the pregnant patient.