Help: Relation of Inguinal Hernia with High Risk Pregnancy Report

Daytonite, BSN, RN · Jan 10, 2007

if you have access to a medical textbook on obstetrics at a medical library you might be able to find something on this. however, i searched a number of pregnancy and surgical sites and found little on it except that the development of inguinal or femoral hernias can commonly occur in pregnancy. nothing about any other uterine ligaments being involved. the main concern is that any inguinal hernia can involve a segment of the intestine and cut off the blood supply to it (strangulation) which would result in peritonitis and gangrene of that portion of the intestine. that would be a surgical emergency and require an emergency hernia repair.

i don't know why they aren't repairing this patient's hernia. ob wasn't my field of practice. my guess is that with labor, a surgical repair might not hold up as well, so repair has to wait until after the birth. what i did find was that some of these hernias occur during labor and the stress and pressure of pushing. otherwise, i would think that the delay would be so as not to put the baby under the stress of the surgery. as long as the hernia is reducible the patient is not in danger--just needs to modify her lifestyle a bit.

i could also be wrong.

here's information from encyclopedia of surgery on both a femoral hernia and inguinal hernia:

inguinal hernia repair - definition, purpose, demographics, description, diagnosis/preparation, aftercare, risks, normal results

http://www.surgeryencyclopedia.com/ce-fi/femoral-hernia-repair.html

http://www.webmd.com/hw/hernia/hw170909.asp - inguinal hernia from webmd

ails · Jan 11, 2007

What is the relation of inguinal hernia to high risk pregnancy? All I know is that when the intestine gets incarcerated in the inguinal canal, it carries with it a uterine ligament. Which is it? And how is it detrimental to pregnancy? Thanks a million!

By the way, here's a copy of the paper I submitted to our instructor. I'm going to do an oral report next week about it, hope you could give me additional inputs: :)

INGUINAL HERNIA
Inguinal Hernia is the protrusion of an organ, usually the intestine, to the inguinal canal. In general, hernias can be congenital or developed.
Causes and Risk Factors
Inguinal Hernia is caused mainly by weakness of the abdominal muscles that may evolve into a localized hole. Because the muscles are weak, hernia can occur during abdominal strain such as obesity, excessive weight gain or loss, pregnancy, heavy lifting, chronic cough, and straining during bowel movements due to constipation that push the intestine into the inguinal canal. Other risk factors are family history, certain medical conditions such as cystic fibrosis, certain occupations that require standing up for long hours, premature birth, and a history of inguinal hernia usually on the opposite side.
Males are more at risk in developing inguinal hernias (About 75% of inguinal hernias are of developed by males) and may be caused by straining during urination due to an enlarged prostate. It occurs less in females due to the small size of their inguinal canal.
Signs and Symptoms
The most obvious symptom of inguinal hernia is a lump on the groin area that is more visible while standing up that when lying down. There is pain or discomfort in the groin especially when bending over, coughing, or lifting. Other symptoms include nausea, vomiting, inability to have bowel movement, and a bulge that remains when lying down.
In males, there is a heavy sensation in the groin area especially the scrotum. Pain and swelling is also present around the scrotum and the testes.
Diagnosis
The doctor will perform a physical examination. The patient is likely to asked for presence of signs and symptoms. Since coughing causes strain, the doctor will ask the patient to cough during the physical examination. If there is hernia, it will bulge as the patient coughs.
X-Ray and blood tests can also be done to assess intestine blockage.
Treatment
Most of the time, hernias can be pushed back up into place. However, some hernias can't be pushed. This may be because of a trapped portion of the intestine or incarcerated portion in the inguinal canal. Another can be because of strangulated hernia, causing less blood flow to the intestine.
Some people with hernia are made to wear a special kind of belt called a truss, in order to prevent the hernia from bulging out.
If pushing back the hernias won't work, then surgical operations will. One would be herniorraphy, the surgical operation where in the surgeon makes an incision and pushes back the protruding intestine back into place. In hernioplasty on the other hand, the surgeon inserts a synthetic or steel mesh, or wire, in the inguinal area and possible hernia openings. This is usually done laparoscopically where the surgeon inserts a fiber-optic camera into the patient's abdomen and using it as a guide.
Prevention
There are several ways in which people can prevent developing hernias. These are maintaining a healthy weight, emphasize high-fiber foods, avoid heavy lifting, and stop smoking. Though some say wearing a truss is helpful, it is not recommended to rely on it too much. It is not the long term solution for an inguinal hernia.
Inguinal Hernia in Relation to Pregnancy and Women
In the inguinal canal, there lies a ligament that helps suspend the uterus in place. If a hernia occurs there, it will carry the ligament with it. Uterine ligaments support the uterus especially AOG above 40 when the fundus is about the level of the xiphoid process. If the hernia carries with it a uterine ligament, there will be diagonal pain from the superior uterus to he groin. The uterus with the baby inside may also be moved due to the pulling of the uterine ligament.

Thanks very much to Daytonite's previous reply. Unfortunately, my first post was removed due to some reasons. Here's an edited post. Thanks again! :imbar