Reply: Surprise Baby: Abdominoplasty Performed During Unknown Pregnancy

We thank Suri et al¹ for their thoughtful commentary on the risks mother and fetus may face during anesthesia. Their observations raise important clinical and ethical implications in the perioperative care of women of reproductive age.

Current guidelines recommend individualized assessment of pregnancy status before elective surgery. The American Society of Anesthesiologists advises against routine testing but supports testing when pregnancy cannot be ruled out.² Similarly, the United Kingdom’s National Institute for Health and Care Excellence recommends informing women of reproductive age and offering testing, respecting patient autonomy.³ At our institution, all premenopausal patients are routinely questioned, and testing is performed if pregnancy remains uncertain.^3,4 For patients with regular cycles and no risk factors, testing may be omitted following documentation.^2,3

At the time of surgery, our patient was in her sixth week of gestation, a period before the typical rise in progesterone levels. The study cited by the authors involved women after the seventh week and cannot be applied to earlier gestational stages.⁵ In our case, anesthesia was uneventful with no airway edema. No pre- or postoperative anemia was observed. Stable weight over several months, including during early undiagnosed pregnancy, fulfilled the prerequisite for abdominoplasty in this postbariatric patient.

The American Society of Anesthesiologists reports no evidence of teratogenicity from standard anesthetic agents. Although spontaneous abortion risk is higher in the first trimester, fetal loss may be more likely in the second.⁶ Data show no significant increase in birth defects following first-trimester surgery. Fetal risks such as miscarriage and preterm birth must be clearly communicated when pregnancy is suspected or testing is declined, but it is equally essential to respect patient autonomy. Testing without consent violates ethical and legal standards.

Our patient had completed childbearing (children 8, 10, and 12 y of age), and pregnancy was ruled out verbally and with written consent. Although no adverse outcomes occurred, we support routine pregnancy screening for women of reproductive age when pregnancy is uncertain. Screening must respect autonomy and consent, and elective procedures should be postponed if pregnancy is confirmed. To our knowledge, this is an extremely rare case with no similar reports to date.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.