Safety and efficacy of colonoscopy during pregnancy: an analysis of pregnancy outcome in 20 patients

Abstract

Objective: To analyze maternal and fetal safety of colonoscopy during pregnancy.

Study design: Retrospective study comparing fetal outcomes at 2 hospitals from 1986 to 2007 of 20 pregnant women undergoing colonoscopy vs. 20 matched pregnant controls not undergoing colonoscopy.

Results: Colonoscopic indications included diarrhea (8), hematochezia (4), bloody diarrhea (3), abdominal pain (2) and other (3). Colonoscopy was performed during the first trimester in 2, second trimester in 16 and third trimester in 2. Colonoscopic intubation was to cecum (11), hepatic flexure (2) and transverse colon (7). Excluding 1 successful therapeutic colonoscopy, colonoscopy was diagnostic in 10 of 19 cases, including ulcerative colitis (5), ischemic colitis (2), Crohn's colitis (2) and lymphocytic colitis (1). Colonoscopy led to therapeutic changes in 7 (35%). Two minor maternal procedural complications occurred (mild, transient hypotension). No fetal distress was detected during colonoscopy by fetal heart rate monitoring in 6 patients. Study patients had 1 involuntary abortion and 1 infant born with congenital defects; all other infants were born relatively healthy. Study patients had similar or lower rates than controls of these unfavorable fetal outcomes: involuntary abortion, premature delivery, low birth weight, congenital defects, neonatal ICU stay, infant postpartum hospitalization > or = 4 days and infant death after live birth. Study infants had similar or higher mean Apgar scores vs. controls at 1 and 5 minutes.

Conclusion: Pregnant patients undergoing colonoscopy tended to have better, but not statistically significant, fetal outcomes than matched pregnant controls not undergoing colonoscopy. Colonoscopy may be relatively safe, without large fetal risks, during the second trimester and may improve fetal outcome. Colonoscopy may be performed when strongly indicated during the second trimester.