Complications involving the gastrointestinal tract, liver, and gallbladder are common in pregnancy. Nausea and vomiting in the first trimester affect the majority of pregnant women to some degree (see Obstetric Complications of the First & Second Trimesters). Nausea and vomiting in the last half of pregnancy, however, are never normal; a thorough evaluation of such complaints is mandatory. Some of these conditions are incidental to pregnancy (eg, appendicitis), while others are related to the gravid state and tend to resolve with delivery (eg, acute fatty liver of pregnancy). Importantly, the myriad anatomic and physiologic changes associated with normal pregnancy must be considered when assessing for a disease state. Likewise, interpretation of laboratory studies must take into account the pregnancy-associated changes in hepatic protein production.
For conditions in which surgery is clinically indicated, operative intervention should never be withheld based solely on the fact that a woman is pregnant. While purely elective surgery is avoided during pregnancy, women who undergo surgical procedures for an urgent or emergent indication during pregnancy do not appear to be at increased risk for adverse outcomes. Obstetric complications, when they occur, are more likely to be associated with the underlying maternal illness. Recommendations have held that the optimal time for semi-elective surgery is the second trimester to avoid exposure to anesthesia in the first trimester and the enlarged uterus in the third. Importantly, however, there is no convincing evidence that general anesthesia induces malformations or increases the risk for abortion.