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1、CHAPTER72SURGERYINTHEPREGNANTPATIENTDeanJ.Mikami,PaulR.Beery,andE.ChristopherEllisoncomparedwiththenonpregnantpatient.Thediaphragmcanbephysiologicchangesofpregnancyelevatedinpregnancyupto4cmandthelowerchestwallcansafetyconcernsinpregnancy1widenupto7cm.Thesechang
2、esmayalsomimicsimilarpreventionofpretermlaborpathophysiologythatoccursinnonpregnantwomenwhohaveabdominalpainandtheacuteabdomeninpregnancycardiacorliverdisease.Elevatedprogesteronelevels,aswellasminimallyinvasivesurgeryinpregnancydecreasedserummotilin,resultinsmo
3、othmusclerelaxation,breastmassesinpregnancyproducingmultipleeffectsonseveralorgansystems.Inthesurgeryfordiseasesinpregnancystomach,thisdecreasedsmoothmuscletoneresultsindimin-traumainpregnancyishedgastrictoneandmotility.Theloweresophagealsphincterpregnancyafterm
4、ajorabdominaloperationstoneisalsodecreasedand,whencombinedwithincreasedintra-abdominalpressure,resultsinanincreaseintheincidenceofsummarygastroesophagealreflux.Smallbowelmotilityisreduced,increas-ingsmallboweltransittime.Absorptionofnutrients,however,remainsunch
5、anged,withtheexceptionofironabsorption,whichisincreasedbecauseofincreasedironrequirements.IntheThepregnantpatientpresentsauniqueclinicalchallenge.Ancolon,pregnancy-relatedchangesusuallymanifestasconstipa-estimated1%to2%ofpregnantwomenrequiresurgicalproce-tion.Th
6、isiscausedbyacombinationofincreasedcolonicdures,withnonobstetricsurgerynecessaryinupto1%ofpreg-sodiumandwaterabsorption,decreasedmotility,andmechani-nanciesintheUnitedStateseachyear.Inareviewof44paperscalobstructionbythegraviduterus.Anincreaseinportalvenousand12
7、,452patients,theeffectsofnonobstetricsurgicalproce-pressure,andthereforeanincreaseinthepressureinthecol-duresonmaternalandfetaloutcomeswerestudied;amaternallateralvenouscirculation,resultsindilationoftheveinsatthedeathrateof0.006%andamiscarriagerateof5.8%weregas
8、troesophagealjunction.Thisisofimportanceonlyifthereported.Mostindicationsforsurgicalinterventionarecommonpatienthadesophagealvaricesbeforebecomingpregnant.Theforthepa
