MULTICENTER, MULTIYEAR EFFICACY OF FLEXIBLE SIGMOIDOSCOPY DURING PREGNANCY IN 24 FEMALES WITH FOLLOW-UP OF FETAL-OUTCOME

Our objectives were to analyze the risks versus benefits of flexible s igmoidoscopy to the pregnant female and fetus. We retrospectively stud ied 24 consecutive pregnant patients admitted to four university hospi tals during seven years who underwent 26 flexible sigmoidoscopies. Sig moidoscopy indications included hematochezia in 11, diarrhea in 12, ab dominal 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. Sigmoido scopy provided helpful clinical information in all patients. Twelve pa tients had a lesion diagnosed by sigmoidoscopy, including reactivation of Crohn's colitis, reactivation of ulcerative colitis, infectious co litis, nonspecific colitis, bleeding internal hemorrhoids, pseudomembr anous 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 a ny pregnant female. Two pregnant patients underwent repeat sigmoidosco py 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 /- 0.4 SD at 1 min, and 9.0 +/- 0.4 SD at 5 min. One diabetic and hype rtensive female suffered an involuntary abortion nine weeks after sigm oidoscopy, which appeared unrelated to the sigmoidoscopy. Four pregnan cies were voluntarily aborted. This study suggests that flexible sigmo idoscopy does not induce labor or result in congenital malformations, that sigmoidoscopy is not contraindicated during pregnancy, and that s igmoidoscopy should be considered in medically stable pregnant patient s with significant gastrointestinal bleeding. Sigmoidoscopy should be performed with maternal monitoring by electrocardiography and pulse ox imetry and possibly with fetal monitoring, after obstetrical consultat ion and after stabilization of vital signs. Medical stabilization may require transfusion of blood products and supplemental oxygen administ ration.