What to do about a hernia during pregnancy?

From the Guidelines

If you develop a hernia during pregnancy, consult your healthcare provider promptly, as surgery can be safely carried out at any time during pregnancy, but should never be postponed if deemed crucial in the management plan 1. When managing a hernia during pregnancy, it's essential to consider the type, size, and symptoms. For mild hernias without complications, conservative management may be recommended, including rest, avoiding heavy lifting, and wearing supportive garments.

• Pain management can often be achieved with acetaminophen (Tylenol) at standard dosing (up to 3000mg daily in divided doses)
• Apply ice packs for 15-20 minutes several times daily to reduce swelling However, if you experience severe pain, vomiting, or inability to pass gas or stool, seek emergency care immediately as these may indicate a strangulated hernia requiring urgent surgery 1. While doctors typically prefer to delay hernia repair until after delivery, emergency surgery may be necessary if complications arise, and patients should be advised about the risks and symptoms of internal herniation and seek medical assistance without delay 1. Hernias during pregnancy often result from increased abdominal pressure as the uterus expands, weakening abdominal muscles and connective tissues.
• Many pregnancy-related hernias resolve naturally after delivery
• Some may require surgical repair later if they persist It's crucial to prioritize maternal and fetal conditions, particularly after the 25th week of gestation, and follow a thorough discussion with the patient and the multidisciplinary team 1.

From the Research

Diagnosis and Treatment of Pregnancy Hernia

• A hernia is an area of weakness or complete disruption of the fibromuscular tissues of the body wall, which can occur in the diaphragm, pelvic wall, perineum, pelvic floor, and internal abdominal viscera 2.
• Abdominal wall hernias are not common during pregnancy, but when they do occur, they can be symptomless or have minimal symptoms, including slight discomfort or pain 2.
• If a hernia is incarcerated or strangulated, emergency repair is obligatory, whereas if the hernia is symptomatic but not complicated, elective surgery should be offered 3.

Timing of Repair

• The timing of repair depends on whether the patient is already pregnant or non-pregnant, as well as the size and symptoms of the hernia 3.
• If the hernia is small and asymptomatic, it may be better to delay the surgery until after delivery or after the last pregnancy 3.
• If the hernia is symptomatic and seems to affect the patient's quality of life, it may be better to postpone the repair until the second trimester or after delivery if complications do not occur 3.

Surgical Approach

• Laparoscopic mesh repair should be offered whenever possible, whereas the open approach may be preferred in complicated cases 3.
• Suture repair may be suitable for both small hernias and in cases of gross contamination 3.
• Elective, postpartum hernia repair provides similar results to the non-pregnant population, with no perioperative or postoperative complications reported in one study 4.

Management and Outcomes

• The approach to treating hernias in pregnancy is strictly individualized and depends on two main factors: the state of emergency and the gestational week of the pregnancy 5.
• Umbilical hernia repair in pregnant patients can be performed with minimal 30-day morbidity to the mother, but additional studies are needed to determine the long-term recurrence rate and the effects of surgical intervention on the fetus 6.