Maternal and fetal outcomes of conscious sedation and endoscopy during pregnancy

The effects of conscious sedation during EGD upon pregnancy and the fetus are unknown. Objectives: To analyze the effects of conscious sedation to the pregnant patient and the fetus. Methods: Retrospective study of consecutive pregnant patients who received conscious sedation for EGD (sedation group). Pregnant patients undergoing EGD without conscious sedation were considered controls. Setting: Six teaching institutions. Study period: 1980 to 1996. Results: There were 37 patients in the sedation group and 11 in the control group. The mean gestation age at the time of endoscopy was 18.9 ±1.3 weeks. There were 11 (23%) patients in the first. 18 (37%) in the second and 19 (40%) in the third trimesters. Medications and their mean doses used for sedation included meperidine: 56.7±3.8 mg (26 patients), midazolam: 2.38±0.34 mg (17 patients), and diazepam: 5.11±0.97 mg (9 patients). Naloxone was used in 3 patients. No changes in blood pressure, heart rate or pulse oximetry were noted before or after the procedures in either group. No endoscopic complications occurred. The type of delivery (cesarean section versus normal vaginal delivery) was not affected by the use of conscious sedation. Pregnancy outcomes were not different between both groups. Group Weight at Birth (lbs) APGAR 1 min APGAR 5 min Excellent outcome* Sedation 5.9±0.6 8.13±0.3 8.7±0.3 23/28(82%) Control 6.5±0.7 8.5±0.2 9.1±0.1 8/8(100%) *12 patients excluded. 9 in the sedation (5 voluntary abortions and 4 unknown pregnancy outcomes) and 3 in the control group (unknown pregnancy outcome). Poor outcomes included 1 abortion and 4 stillbirths occurring in high risk pregnancies and unrelated to the EGD and/or sedation. In 4 cases with fetal heart monitoring, EGD did not induce rate abnormalities (pre-sedation: 142.5+3.9 beats/min; post-sedation=145.5+3.7 beats/min). Conclusions: 1) Conscious sedation did not induce hypotension, hypoxemia, or arrhythmias in the mother. 2) It did not have an adverse effect on fetal outcome. 3) This study suggests that conscious sedation with the medications and dosages used is not contraindicated in pregnancy.