Fox, SR; Gorrepati, N; Cappell, MS
Purpose: Whereas colonoscopy is relatively safe in the general population, the safety of colonoscopy during pregnancy is inadequately studied with only 15 reported cases. The safety of colonoscopy during pregnancy involves the unique issue of fetal safety. We analyze the fetal safety of colonoscopy in 23 pregnant patients. Results: 23 patients (8 primigravida, 15 multigravida) underwent colonoscopy during pregnancy from 1986 through 2006 at William Beaumont Hospitals. Their mean age was 29.7 + 4.7 years (range 20 and #150;38 years). Mean gestational age at colonoscopy was 17.9 + 7.8 weeks (range 2 and #150;33 weeks). 4 patients had colonoscopy during 1st trimester, 16 in 2nd trimester and 3 in 3rd trimester (13 as inpatients). Colonic preps included: oral sodium phosphate in 5 patients, sodium phosphate enema in 4, magnesium citrate in 3, polyethylene glycol in 4 and other in 5 (no prep in 1). Anesthetic agents included meperidine (N = 7), fentanyl (N = 6), thiopental (N = 4), midazolam (N = 2), morphine sulfate (N = 2), and other in 3 (unsedated in 6). Mean duration of endoscopy was 19.4 + 10.3 min (range 8 and #150;45). The procedure was well tolerated in 78%. Primary indications for colonoscopy: hematochezia in 10, diarrhea in 4, foreign body in 1, and other in 8. Major new findings/therapy included: new ulcerative colitis in 3, hemorrhoids in 3, ischemic colitis in 3, established IBD in 2, foreign body removal in 1, new Crohn's in 1, and other in 4 (normal colonoscopy in 6). The cecum was reached in 14, transverse colon in 6, hepatic flexure in 2, and near splenic flexure in 1 pt. Three patients underwent snare polypectomy, and 2 had hot biopsy. Patients were hospitalized for 2.6 + 4.7 days (range 0 and #150;20) after index colonoscopy. Maternal colonoscopy complications include hypotension in 3 and minor symptoms in 6. Two patients had spontaneous abortions (both in 1st trimester; 5 days and 5 weeks after colonoscopy). All other infants were delivered alive with no congenital malformations noted in the infant nursery. Mean age of gestation at delivery was 37.8 wks + 2.2 (N = 19, range 33 and #150;40). Mean APGAR score at 1 min was 8.1+ 1.0 (N = 20, range 5 and #150;9), and at 5 min was 9.0 + 0.3 (N = 19, range 8 and #150;9), birth weight 3.1 + 0.6 Kg (N = 19, range 1.9 and #150;4.2). Fetal outcomes (N = 19) included low birth weight ( and lt; 2500 grams) in 2 infants, twin gestation in 1 and premature delivery ( and lt;37 wks) in 9. Conclusion: Colonoscopy appears to be relatively safe and can be performed when strongly indicated in the 2nd and 3rd trimesters of pregnancy.