Another pregnant cholecystectomy thread

[pgg]

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Otherwise healthy woman, 26 weeks pregnant, scheduled for lap chole. Hospital does no high risk OB (at least not deliberately) and has no NICU. Transport times to a hospital with a NICU are well over an hour.

Would anyone defer this case to another hospital?

Odds of preterm labor are very low, but they're not zero and not having the capability to manage a premature neonate strikes me as a little concerning.

Although this isn't a difficult or overly risky case, one of the most basic tenets of medicine is to have the capacity to handle your own complications before you do stuff. There are practical limits of course; any laparoscopic surgeon could put a trocar into the aorta, but we don't only do laparoscopic surgery in hospitals with vascular surgeons and top notch blood banks.


So - the question is, should non-urgent (but also non-elective) nonobstetric surgery in a woman with viable fetus be done at a facility that can provide the level of care a premature neonate needs?



Out in BFE is we have learned to be extremely conservative when OK'ing the surgery schedule. I often find myself thinking twice about things I never would have worried about before.

 

[sevoflurane]

Otherwise healthy woman, 26 weeks pregnant, scheduled for lap chole. Hospital does no high risk OB (at least not deliberately) and has no NICU. Transport times to a hospital with a NICU are well over an hour.

Would anyone defer this case to another hospital?

Odds of preterm labor are very low, but they're not zero and not having the capability to manage a premature neonate strikes me as a little concerning.

Although this isn't a difficult or overly risky case, one of the most basic tenets of medicine is to have the capacity to handle your own complications before you do stuff. There are practical limits of course; any laparoscopic surgeon could put a trocar into the aorta, but we don't only do laparoscopic surgery in hospitals with vascular surgeons and top notch blood banks.


So - the question is, should non-urgent (but also non-elective) nonobstetric surgery in a woman with viable fetus be done at a facility that can provide the level of care a premature neonate needs?



Out in BFE is we have learned to be extremely conservative when OK'ing the surgery schedule. I often find myself thinking twice about things I never would have worried about before.

We would ship them unless this is a true emergency (community hospital). If they do have an issue wacha gonna do? 26weeks, RDS, IVH, pedi vent, nicu staff/nurses. Just not worth it for us.

 

[epidural man]

Otherwise healthy woman, 26 weeks pregnant, scheduled for lap chole. Hospital does no high risk OB (at least not deliberately) and has no NICU. Transport times to a hospital with a NICU are well over an hour.

Would anyone defer this case to another hospital?

Odds of preterm labor are very low, but they're not zero and not having the capability to manage a premature neonate strikes me as a little concerning.

Although this isn't a difficult or overly risky case, one of the most basic tenets of medicine is to have the capacity to handle your own complications before you do stuff. There are practical limits of course; any laparoscopic surgeon could put a trocar into the aorta, but we don't only do laparoscopic surgery in hospitals with vascular surgeons and top notch blood banks.


So - the question is, should non-urgent (but also non-elective) nonobstetric surgery in a woman with viable fetus be done at a facility that can provide the level of care a premature neonate needs?



Out in BFE is we have learned to be extremely conservative when OK'ing the surgery schedule. I often find myself thinking twice about things I never would have worried about before.

Very little downside to go to the other place...possible big upside.

 

[pgg]

Just a few poll responses so far but that's what I figured.


Yesterday GS added on the case for today after consulting OB and anesthesia (not me) who were both OK with it. Ultimately peds balked, said no, and GS amicably agreed to refer her out.

(Which mercifully spared me or the anesthesia DH from being the bad guy today and reversing yesterday's anesthesia OK.)

 

[IN2B8R]

Otherwise healthy woman, 26 weeks pregnant, scheduled for lap chole. Hospital does no high risk OB (at least not deliberately) and has no NICU. Transport times to a hospital with a NICU are well over an hour.

Would anyone defer this case to another hospital?

Odds of preterm labor are very low, but they're not zero and not having the capability to manage a premature neonate strikes me as a little concerning.

Although this isn't a difficult or overly risky case, one of the most basic tenets of medicine is to have the capacity to handle your own complications before you do stuff. There are practical limits of course; any laparoscopic surgeon could put a trocar into the aorta, but we don't only do laparoscopic surgery in hospitals with vascular surgeons and top notch blood banks.


So - the question is, should non-urgent (but also non-elective) nonobstetric surgery in a woman with viable fetus be done at a facility that can provide the level of care a premature neonate needs?



Out in BFE is we have learned to be extremely conservative when OK'ing the surgery schedule. I often find myself thinking twice about things I never would have worried about before.

The obvious answer to an obvious question is obvious: don't do the fuggin' case if you don't have the means to care for potential complications.... You can probably stand up in a canoe in the midst of a ragging river, does not mean that you SHOULD do it....😉

 

[Ketafol20]

Just to be the devils advocate here.

What's the chance that there will be a adverse outcome to mom or baby? I don't know and that is why I'm asking. I assume it is very small.

What's the burden placed on the family for having to travel a few hours to have this surgery? It ain't small but it ain't huge either I assume. Did anyone investigate this?

Couldn't the arrangements be made for transport for mom and baby now, before surgery, just in case things go wrong? If something goes wrong and she goes into premature labor and we all no this still takes some time, she could be transported at this time with an OB and NICU waiting. Isn't that what happens. The surgery goes fine and latter the mom starts to contract. This can be dealt with. Also your OBs can be intimately involved with bigger center OBs kept abreast.

As long as a trochar is placed into the uterus, I think this could be done at outside site. The pt needs to be informed of these issues and she needs to decide.

Just my 2 cents.

 

[Arch Guillotti]

Relax, don't do it.

 

[Lightwand]

Relax, don't do it.

🤣