Common Gynecological Procedures to Ask About During Pregnancy History Intake
When taking a history from pregnant patients, it is essential to inquire about previous gynecological procedures as they may significantly impact pregnancy management, maternal morbidity, mortality, and quality of life.
Key Gynecological Procedures to Ask About
Surgical Procedures
- Previous cesarean sections - Critical to document as this affects delivery planning and risk assessment for vaginal birth after cesarean (VBAC) 1
- Cervical procedures:
- Cone biopsy/conization - Associated with increased risk of preterm delivery and cervical insufficiency 2
- LEEP (Loop Electrosurgical Excision Procedure)
- Cervical cerclage in previous pregnancies
- Uterine surgeries:
- Myomectomy - Particularly important to know the surgical approach and if the endometrial cavity was entered
- Hysteroscopic procedures (septum resection, polyp removal)
- Tubal surgeries:
- Tubal ligation - Important for ectopic pregnancy risk assessment 3
- Salpingectomy
- Tubal reconstruction
- Ovarian surgeries:
- Oophorectomy (partial or complete)
- Ovarian cystectomy
- Adnexectomy 4
- Other pelvic surgeries:
- Previous laparoscopy or laparotomy for endometriosis
- Adhesiolysis
- Appendectomy
Diagnostic Procedures
- Hysteroscopy - To evaluate uterine cavity
- Laparoscopy - For diagnostic evaluation of pelvic organs
- Colposcopy - For cervical evaluation 2
- Endometrial biopsy - For evaluation of uterine lining
Procedure-Specific Considerations
Cesarean Section History
- Document number of previous cesarean sections
- Type of uterine incision (low transverse, classical, T-shaped)
- Complications during previous cesarean (hemorrhage, infection, difficult delivery)
- Interval between cesarean and current pregnancy (risk of uterine rupture increases with shorter intervals) 5
Cervical Procedures
- Timing of procedure relative to current pregnancy
- Amount of cervical tissue removed
- Post-procedure complications
- Cervical length measurements in current or previous pregnancies
Cancer-Related Procedures
For patients with history of gynecologic cancer treatment during a previous pregnancy:
- Staging procedures performed (lymphadenectomy, biopsies)
- Surgical approach used (laparoscopic vs. open)
- Timing of surgery relative to pregnancy stage 4, 6
Impact on Current Pregnancy Management
Risk Assessment
- Previous cesarean section: Affects decision for VBAC vs. repeat cesarean; risk factors for unsuccessful VBAC include BMI >25 kg/m², gestation ≥40 weeks, and high fetal station 5
- Cervical procedures: May require cervical length monitoring and consideration of cerclage
- Pelvic surgeries: May increase risk of adhesions affecting fetal positioning or placentation
Surgical Considerations During Current Pregnancy
If surgery becomes necessary during the current pregnancy:
- Laparoscopic procedures should be limited to 90-120 minutes with low intra-abdominal pressure (10-13 mmHg) 4
- Surgery is preferably performed in early second trimester when risk of miscarriage is decreased 4
- Left lateral tilt positioning is recommended during procedures 4
Documentation Recommendations
- Obtain surgical records when possible for detailed information
- Document specific details about previous procedures including:
- Date of procedure
- Indication
- Surgical approach
- Complications
- Post-procedure pathology results (especially for cancer-related procedures)
By thoroughly documenting previous gynecological procedures during pregnancy history intake, providers can better anticipate potential complications and develop appropriate management plans to optimize maternal and fetal outcomes.