What precautions should female surgical trainees take during pregnancy to minimize the risk of preterm delivery?

Minimizing Preterm Delivery Risk for Female Surgical Trainees During Pregnancy

Female surgical trainees should limit operating time to less than 12 hours per week during the third trimester, maintain adequate hydration and rest breaks, avoid prolonged standing, and consider modified call schedules to reduce the significantly higher risk of preterm delivery and pregnancy complications they face compared to non-surgeons.

Understanding the Risk Profile

Female surgeons face unique occupational hazards during pregnancy that contribute to higher rates of complications:

• Female surgeons experience pregnancy loss at approximately 42% - more than twice the rate of the general population 1
• Female surgeons have a 48.3% risk of major pregnancy complications compared to 27.2% in non-surgeon partners 1
• Operating 12 or more hours per week during the third trimester significantly increases the risk of major pregnancy complications (OR 1.57) 1
• Female surgeons are more likely to experience musculoskeletal disorders (36.9%), non-elective cesarean deliveries (25.5%), and postpartum depression (11.1%) 1

Specific Precautions During Surgical Training

First Trimester

• Limit exposure to potential teratogens:
  • Request information from your program about workplace exposures that may pose risks of fetal anomalies or miscarriage 2
  • Avoid handling certain chemotherapeutic agents and anesthetic gases without proper protection
  • Consider delegating procedures with significant radiation exposure

Second Trimester

• Modify physical work conditions:
  • Use compression stockings to prevent venous stasis
  • Request scheduled rest breaks (only 47.1% of programs currently incorporate these) 2
  • Stay well-hydrated throughout the day
  • Use proper body mechanics during procedures to minimize musculoskeletal strain

Third Trimester

• Reduce physical strain:
  • Limit operating time to less than 12 hours per week to reduce complication risk 1
  • Avoid prolonged standing without breaks
  • Request positioning accommodations during longer cases
  • Consider modified call schedules (only 24.2% of programs currently adjust these) 2
  • Maintain left lateral positioning when possible during longer procedures to prevent aortocaval compression

Institutional Support to Request

• Formal pregnancy policy: 84.4% of surgical programs report having policies, but many are deficient in addressing critical aspects of training 2
• Protected time for prenatal appointments
• Modified call schedules: Request reduced overnight shifts, especially in the third trimester
• Contingency plans: Only 40% of programs have plans to support non-childbearing residents who take on additional work 2
• Protected time for miscarriage recovery: Only 60.3% of programs currently provide this 2

Exercise and Activity Considerations

Current evidence supports that physical activity during pregnancy is generally safe and may even help prevent preterm birth in certain populations:

• Women with short cervix who exercise >2 days/week for >20 minutes showed a non-significant reduction in delivery before 37 weeks (adjusted OR: 0.65) 3
• Physical activity was significantly lower in women at risk for preterm birth who delivered before 37 weeks compared to those delivering at term 3
• Women with short cervix should avoid high-impact/strenuous exercise but should be encouraged to meet general physical activity recommendations 3

Preparing for Delivery

• Consider induction of labor at 40 weeks if there are any cardiac or other medical concerns, as recommended for women with cardiac disease 3
• Develop a comprehensive delivery plan with your obstetrician that accounts for your work schedule and potential need for early delivery
• Arrange for adequate postpartum support, especially given the higher risk of postpartum depression among female surgeons 1

Common Pitfalls to Avoid

1. Delaying family planning due to training: 65% of female surgeons delay having children because of surgical training 1
2. Inadequate hydration and nutrition during long surgical cases
3. Failing to request accommodations due to concerns about perception
4. Ignoring early warning signs of complications
5. Returning to full surgical duties too quickly postpartum

Female surgical trainees face significant challenges during pregnancy that require proactive management and institutional support. By implementing these precautions, the risk of preterm delivery and other pregnancy complications can be substantially reduced.