Gebelikte Acil Cerrahi Durumlar
Özet
Gebelikte obstetrik olmayan cerrahi girişim ihtiyacı, yaklaşık %1 oranında görülmekte olup en sık apandisit ve kolesistit gibi akut batın patolojileri nedeniyle ortaya çıkmaktadır. Cerrahi müdahaleler, acil durumlarda fetusun içinde bulunduğu trimester dönemine bakılmaksızın derhal uygulanmalıdır; ancak doğumu bekleyemeyecek elektif dışı işlemlerde organogenezin tamamlandığı ikinci trimester en güvenli dönem olarak kabul edilir. Anestezik ilaçların insanlarda doğrudan teratojenik etkisi kanıtlanmamış olsa da progesteron seviyesini düşüren sugammadeks kullanımından kaçınılması önerilir. Cerrahi operasyonlar erken doğum, düşük doğum ağırlığı ve ölü doğum gibi obstetrik riskleri ılımlı düzeyde artırabilir; fakat enfeksiyöz patolojilerde müdahalenin geciktirilmesi anne ve fetus için çok daha yüksek mortalite riski taşır. Preoperatif dönemde trombofili riskine karşı mekanik veya farmakolojik tromboprofilaksi uygulanmalı, postoperatif süreçte ise sol lateral pozisyon, etkin ağrı yönetimi ve fetal kalp atımı takibi titizlikle sürdürülmelidir. Apandisitte zamanında cerrahi, perforasyon kaynaklı fetal kayıpları önlemede kritik öneme sahipken, akut kolesistit ve biliyer pankreatit durumlarında da konservatif yaklaşım yerine cerrahi ilk seçenek haline gelmiştir. Sonuç olarak, gebelikte acil cerrahi yönetim; multidisipliner bir yaklaşım, klinik şüphe, erken tanı ve gecikmesiz operasyonla anne ile fetus güvenliğini optimal düzeyde sağlamayı amaçlar.
The need for non-obstetric surgery during pregnancy occurs in approximately 1% of gestations, predominantly driven by acute abdominal pathologies such as appendicitis and cholecystitis. Emergency surgical interventions must be performed immediately regardless of the gestational trimester, whereas for operations that cannot wait until delivery, the second trimester is preferred to minimize risks to organogenesis. While anesthetic agents lack proven teratogenic effects in humans, the routine use of sugammadex should be avoided due to its potential to lower progesterone levels. Surgical procedures moderately increase obstetric complications, including preterm labor, low birth weight, and stillbirth; however, delaying treatment for infectious conditions poses a significantly higher risk of maternal and fetal mortality. Preoperatively, thromboprophylaxis is essential to counteract the hypercoagulable state of pregnancy, while postoperative care requires strict adherence to left lateral positioning, multimodal analgesia, and close monitoring of fetal heart rate. Prompt appendectomy is vital to prevent perforation-related fetal loss, and surgery has increasingly become the primary choice over conservative management for cholecystitis and biliary pancreatitis. Ultimately, managing surgical emergencies in pregnant patients requires high clinical suspicion, timely diagnosis, and a multidisciplinary approach to ensure both maternal and fetal safety.
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