Digestive Diseases and Sciences

, Volume 41, Issue 12, pp 2353–2361 | Cite as

A study at 10 medical centers of the safety and efficacy of 48 flexible sigmoidoscopies and 8 colonoscopies during pregnancy with follow-up of fetal outcome and with comparison to control groups

  • Mitchell S. Cappell
  • Victor J. Colon
  • Osama A. Sidhom
Diagnostic And Interventional Techniques


To analyze the risks versus benefits of flexible sigmoidoscopy and colonoscopy to the pregnant female and fetus, we conducted a multiyear, retrospective study at 10 hospitals of 46 patients undergoing 48 sigmoidoscopies and 8 patients undergoing 8 colonoscopies during pregnancy. Sigmoidoscopy controls included two study control groups and the average American pregnancy outcomes. Sigmoidoscopy indications included hematochezia in 28, diarrhea in 10, abdominal pain in 4, and other in 3. Thirteen patients were in the first trimester of pregnancy, 18 were in the second trimester, and 15 were in the third trimester. Twenty-seven patients had a lesion diagnosed by sigmoidoscopy, including reactivated or newly diagnosed inflammatory bowel disease, bleeding internal hemorrhoids, and other colitidies. Twenty-two of 29 patients with rectal bleeding had a significant lesion identified by sigmoidoscopy. Sigmoidoscopy was significantly more frequently diagnostic for hematochezia than for other indications (p < 0.03, χ2). No endoscopic complications occurred to the pregnant patients. Excluding 4 voluntary abortions and 1 unknown pregnancy outcome, 38 (93%) of 41 pregnant females delivered healthy babies (study control rate=93%; NS, Fisher's exact test). Mean live-born infant Apgar scores were 8.2 ± 1.5 (SD) at 1 min and 9.0 ± 0.2 at 5 min (control mean Apgar scores: 8.1 ± 1.7 at 1 min and 8.8 ± 1.0 at 5 min; NS, Student'st test). Three high-risk pregnancies ended with fetal demise at 8, 9, or 12 weeks after sigmoidoscopy, from causes unrelated to sigmoidoscopy. No fetal cardiac abnormalities were detected by fetal cardiac monitoring during two sigmoidoscopies. Eight pregnant females underwent colonoscopy, without complications. Pregnancy outcomes included six healthy babies delivered at full term, one voluntary abortion, and one fetal demise in a high-risk pregnancy 4 months after colonoscopy from causes unrelated to colonoscopy. This study suggests that sigmoidoscopy does not induce labor or result in congenital malformations, that sigmoidoscopy is not contraindicated during pregnancy, and that sigmoidoscopy may be beneficial in pregnant patients with significant lower gastrointestinal bleeding. Colonoscopy during pregnancy should be considered for life-threatening lower gastrointestinal bleeding or when the only alternative is surgery.

Key words

pregnancy parturition congenital anomalies teratology neonatology lower gastrointestinal bleeding flexible sigmoidoscopy colonoscopy gastrointestinal endoscopy endoscopic complications therapeutic endoscopy 


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  1. 1.
    Cappell MS, Colon VJ, Sidhom OA: A multicenter study of the safety and efficacy of flexible sigmoidoscopy and colonoscopy during pregnancy in 39 females with follow-up of fetal outcome (abstract). Gastroenterology 108(4; Suppl):A276, 1995Google Scholar
  2. 2.
    Hunter JG: Endoscopic laser applications in the gastrointestinal tract. Surg Clin North Am 69:1147–1166, 1989PubMedGoogle Scholar
  3. 3.
    Arrowsmith JB, Gerstman BB, Fleischer DE, Benjamin SB: Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 37:421–427, 1991PubMedGoogle Scholar
  4. 4.
    Eimiller A: Complication in endoscopy. Endoscopy 24:176–184, 1992PubMedGoogle Scholar
  5. 5.
    Hart R, Classen M: Complications of diagnostic gastrointestinal endoscopy. Endoscopy 22:229–233, 1990PubMedGoogle Scholar
  6. 6.
    Alvarado CJ, Stolz MS, Maki DG, Fraser V, Jones M, O'Rourke S, Wallace RJ Jr: Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes: Wisconsin and Missouri. JAMA 266:2197–2198, 1991PubMedGoogle Scholar
  7. 7.
    Rankin GB: Indications, contraindications, and complications of colonoscopy.In MV Sivak Jr (ed). Gastroenterologic Endoscopy, Philadelphia, WB Saunders, 1987, pp 868–880Google Scholar
  8. 8.
    Waye JD, Lewis BS, Yessayan S: Colonoscopy: A prospective report of complications. J Clin Gastroenterol 15:347–351, 1992PubMedGoogle Scholar
  9. 9.
    National Center for Health Statistics, U.S. Department of Health and Human Services: Vital Statistics of the United States 1989, Vol. I. Natality. Washington, DC, U.S. Government Printing Office, 1993Google Scholar
  10. 10.
    Brent RL: The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: Counseling the pregnant and nonpregnant patient about these risks. Semin Oncol 16:347–368, 1989PubMedGoogle Scholar
  11. 11.
    Alstead EM, Ritchie JK, Lennard-Jones JE,et al. Safety of azathioprine in pregnancy in inflammatory bowel disease. Gastroenterology 99:443–446, 1990PubMedGoogle Scholar
  12. 12.
    Connon J: Gastrointestinal complications.In Medical Complications During Pregnancy, GN Burrow, TF Ferris (eds). Philadelphia, WB Saunders, 1988, pp 303–317Google Scholar
  13. 13.
    Saunders P, Milton PJD: Laparotomy during pregnancy: An assessment of diagnostic accuracy and fetal wastage. Br Med J 3:165–167, 1973PubMedGoogle Scholar
  14. 14.
    Tamir IL, Bongard FS, Klein SR: Acute appendicitis in the pregnant patient. Am J Surg 160:571–576, 1990PubMedGoogle Scholar
  15. 15.
    Cappell MS, Sidhom OA: A multicenter, multiyear study of the safety and clinical utility of flexible sigmoidoscopy in 24 consecutive pregnant females with follow-up of fetal outcome. Dig Dis Sci 40:472–479, 1995PubMedGoogle Scholar
  16. 16.
    Cappell MS, Sidhom O: A multicenter, multiyear study of the safety and clinical utility of esophagogastroduodenoscopy in 20 consecutive pregnant females with follow-up of fetal outcome. Am J Gastroenterol 88:1900–1905, 1993PubMedGoogle Scholar
  17. 17.
    Cappell MS, Sidhom OA, Colon V: A study at eight medical centers of the safety and clinical efficacy of esophagogastroduodenoscopy in 83 pregnant females with follow-up of fetal outcome and with comparison to control groups. Am J Gastroenterol 91:348–354, 1996PubMedGoogle Scholar
  18. 18.
    National Center for Health Statistics, U.S. Department of Health and Human Services: Health United States 1992 and Healthy People 2000 Program. Hyattsville, MD, Public Health Service, 1993Google Scholar
  19. 19.
    Rubin PH, Janowitz HD: The digestive tract and pregnancy.In Complications of Pregnancy: Medical, Surgical, Gynecologic, Psychosocial, and Perinatal, 4th ed SH Cherry, IR Merkatz (eds). Baltimore, Williams & Wilkins, 1991, pp 780–796Google Scholar
  20. 20.
    Singer AJ, Brandt LJ: Pathophysiology of the gastrointestinal tract during pregnancy. Am J Gastroenterol 86:1695–1712, 1991PubMedGoogle Scholar
  21. 21.
    Bernstein MA, Madoff RD, Caushaj PF: Colon and rectal cancer in pregnancy. Dis Colon Rectum 36:172–178, 1993PubMedGoogle Scholar
  22. 22.
    Brackbill Y, Kane J, Manniello RL, Abramson D: Obstetric meperidine usage and assessment of neonatal status. Anesthesiology 40:116–120, 1974PubMedGoogle Scholar
  23. 23.
    Epstein H, Waxman A, Gleicher N,et al. Meperidine-induced sinusoidal fetal heart rate pattern and reversal with naloxone. Obstet Gynecol 59 (Suppl):22–25, 1982Google Scholar
  24. 24.
    Melmed AP: Anesthesia principles and techniques in pregnancy.In Complications of Pregnancy: Medical, Surgical, Gynecologic, Psychosocial, and Perinatal, 4th ed, SH Cherry, IR Merkatz (eds). Baltimore, Williams & Wilkins, 1991, pp 732–764Google Scholar
  25. 25.
    Rosenberg L, Mitchell AA, Parsells JL, Pashayan H, Louik C, Shapiro S: Lack of relation of oral clefts to diazepam use during pregnancy. N Engl J Med 309:1282–1285, 1983PubMedGoogle Scholar
  26. 26.
    Dark DS, Campbell DR, Wesselius LJ: Arterial oxygen desaturation during gastrointestinal endoscopy. Am J Gastroenterol 85:1317–1321, 1990PubMedGoogle Scholar
  27. 27.
    McKee CC, Ragland JJ, Myers JO: An evaluation of multiple clinical variables for hypoxia during colonoscopy. Surg Gynecol Obstet 173:37–40, 1991PubMedGoogle Scholar
  28. 28.
    Hampton KK, Grant PJ, Primrose J, Dean HG, Davies JA, Prentice CR: Haemostatic responses and vasopressin release during colonoscopy in man. Clin Sci 81:257–260, 1991PubMedGoogle Scholar
  29. 29.
    Simon IB, Lewis RJ, Satava RM. A safe method for sedating and monitoring patients for upper and lower gastrointestinal endoscopy. Am Surg 57:219–221, 1991PubMedGoogle Scholar
  30. 30.
    DiSario JA, Waring JP, Talbert G, Sanowski RA: Monitoring of blood pressure and heart rate during routine endoscopy: A prospective, randomized, controlled study. Am J Gastroenterol 86:956–960, 1991PubMedGoogle Scholar
  31. 31.
    Bollaert PE, Bauer P, Judlin P, Laprevote-Heully MC, Lambert H, Larcan A: Hemorrhagic colitis withStreptococcus pyogenes preceding hemolytic uremic syndrome during early pregnancy (letter). Nephron 52:103–104, 1989PubMedGoogle Scholar
  32. 32.
    Bornman PC, Collins JS, Abrahamson MJ, Gilinsky NH: Live abdominal pregnancy presenting as massive rectal bleeding. Postgrad Med J 61:759–760, 1985PubMedGoogle Scholar
  33. 33.
    Cooksey G, Gunn A, Wotherspoon WC: Surgery for acute ulcerative colitis and toxic megacolon during pregnancy. Br J Surg 72:547, 1985PubMedGoogle Scholar
  34. 34.
    Moeller DD: Crohn's disease beginning during pregnancy. South Med J 81:1067, 1988PubMedGoogle Scholar
  35. 35.
    Sheld HH: Megacolon complicating pregnancy: A case report. J Reprod Med 32:239–242, 1987PubMedGoogle Scholar
  36. 36.
    Fraser JL, Eckert LA: Volvulus complicating pregnancy (letter). Can Med Assoc J 128:1045–1048, 1983PubMedGoogle Scholar
  37. 37.
    Nesbitt JC, Moise KJ, Sawyers JL: Colorectal carcinoma in pregnancy. Arch Surg 120:636–640, 1985PubMedGoogle Scholar
  38. 38.
    Schade RR, van Thiel DH, Gavaler JS: Chronic idiopathic ulcerative colitis: Pregnancy and fetal outcome. Dig Dis Sci 29:614–619, 1984PubMedGoogle Scholar
  39. 39.
    Salinas A, Guelrud M, Toledano A, Dreiling DA: Abdominal pregnancy causing massive lower gastrointestinal bleeding: Case report. Mt Sinai J Med 52:371–374, 1985PubMedGoogle Scholar
  40. 40.
    Patterson SP, Frankum CE, Sexton H: Ectopic pregnancy causing massive rectal bleeding. South Med J 71:1449–1450, 1978PubMedGoogle Scholar
  41. 41.
    Frank B: Endoscopy in pregnancy.In Gastrointestinal disorders during pregnancy, Karlstadt RG, Surawicz CM, Croitoru R (eds). Annual convention handout, American College of Gastroenterology, 1994Google Scholar
  42. 42.
    Berg JC, Miller R, Burkhalter E: Clinical value of pulse oximetry during routine diagnostic and therapeutic endoscopic procedures. Endoscopy 23:328–330, 1991PubMedGoogle Scholar
  43. 43.
    Gonsoulin W, Mason B, Carpenter RJ Jr: Colon cancer in pregnancy with elevated maternal alpha-fetoprotein level at presentation. Am J Obstet Gynecol 163:1172–1173, 1990PubMedGoogle Scholar
  44. 44.
    Woods JB, Martin JN Jr, Ingram FH, Odom CD, Scott-Conner CE, Rhodes RS: Pregnancy complicated by carcinoma of the colon above the rectum. Am J Perinatol 9:102–110, 1992PubMedGoogle Scholar
  45. 45.
    Bashir RM, Montgomery EA, Gupta PK, Nauta RM, Crockett SA, Collea JV, Al-Kawas FH: Massive gastrointestinal hemorrhage during pregnancy caused by ectopic decidua of the terminal ileum and colon. Am J Gastroenterol 90:1325–1327, 1995PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1996

Authors and Affiliations

  • Mitchell S. Cappell
    • 3
    • 1
    • 2
  • Victor J. Colon
    • 3
    • 1
    • 2
  • Osama A. Sidhom
    • 3
    • 1
    • 2
  1. 1.the Department of MedicineUMDNJ-Robert Wood Johnson Medical SchoolNew Brunswick
  2. 2.the Gastroenterology Division, Department of MedicineUniversity of Southern California School of MedicineLos Angeles
  3. 3.Division of GastroenterologyMaimonides Medical CenterBrooklyn

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