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Multicenter, multiyear study of safety and efficacy of flexible sigmoidoscopy during pregnancy in 24 females with follow-up of fetal outcome

  • Diagnostic And Interventional Techniques
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Abstract

Our objectives were to analyze the risks versus benefits of flexible sigmoidoscopy to the pregnant female and fetus. We retrospectively studied 24 consecutive pregnant patients admitted to four university hospitals during seven years who underwent 26 flexible sigmoidoscopies. Sigmoidoscopy indications included hematochezia in 11, diarrhea in 12, abdominal pain in 7, constipation in 2, and occult rectal bleeding in 1. Seven patients were in the first trimester of pregnancy, nine were in the second trimester, and eight were in the third trimester. Sigmoidoscopy provided helpful clinical information in all patients. Twelve patients had a lesion diagnosed by sigmoidoscopy, including reactivation of Crohn's colitis, reactivation of ulcerative colitis, infectious colitis, nonspecific colitis, bleeding internal hemorrhoids, pseudomembranous colitis, anastomotic ulcer, and newly diagnosed Crohn's colitis. In particular, nine of 11 patients with rectal bleeding had a lesion identified by sigmoidoscopy. No endoscopic complications occurred to any pregnant female. Two pregnant patients underwent repeat sigmoidoscopy without complications. Fetal outcome was ascertained in all but one pregnancy. Eighteen pregnant females delivered healthy infants (16 at full term, two at 35 or 36 weeks). Their mean Apgar scores were 8.8±0.4sd at 1 min, and 9.0±0.4sd at 5 min. One diabetic and hypertensive female suffered an involuntary abortion nine weeks after sigmoidoscopy, which appeared unrelated to the sigmoidoscopy. Four pregnancies were voluntarily aborted. This study suggests that flexible sigmoidoscopy does not induce labor or result in congenital malformations, that sigmoidoscopy is not contraindicated during pregnancy, and that sigmoidoscopy should be considered in medically stable pregnant patients with significant gastrointestinal bleeding. Sigmoidoscopy should be performed with maternal monitoring by electrocardiography and pulse oximetry and possibly with fetal monitoring, after obstetrical consultation and after stabilization of vital signs. Medical stabilization may require transfusion of blood products and supplemental oxygen administration.

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Authors and Affiliations

  1. From the Division of Gastroenterology, Department of Medicine, UMDNJ-Robert Wood Johnson (formerly Rutgers) Medical School, New Brunswick, New Jersey

    Mitchell S. Cappell MD, PhD (Director) & Osama Sidhom MD

  2. the Clinical Pharmacology Center, Department of Medicine, Northwestern University Medical School, Chicago, Illinois

    Mitchell S. Cappell MD, PhD (Director) & Osama Sidhom MD

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  1. Mitchell S. Cappell MD, PhD
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  2. Osama Sidhom MD
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Cappell, M.S., Sidhom, O. Multicenter, multiyear study of safety and efficacy of flexible sigmoidoscopy during pregnancy in 24 females with follow-up of fetal outcome. Digest Dis Sci 40, 472–479 (1995). https://doi.org/10.1007/BF02065437

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  • DOI: https://doi.org/10.1007/BF02065437

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