Vicodin or Surgery??

[breezy5]

My best friend is about 6.5 months pregnant. She just got news that she has gallstones and an infection, and her gallbladder needs to be removed. She has been takin vicodin 1 pill 5/500mg everynight for about a week to help her sleep. Which is safer? Having the gallbladder removed while she is pregnant or taken 1 vicodin a day and waiting until after the baby is born. She does not want her baby to have defects or become addicted and she does not want the surgery while she is pregnant. Kinda between a rock and a hard place. Any advice??

[Tweety, BSN, RN]

And there is already an infection there? Just a set up for anything else to happen.

That to me is the worrisome part of the equation. Where is the infection.

[Marie_LPN, RN, LPN, RN]

I thought the poster was saying the infection was in the gallbladder?

[suzanne4, RN]

That is what I was referring to........with infection, you are talking of cholecystitis. This means inflammation of the gallbladder and anything can and will happen. If just straight cholelithiasis you could probably just sit on it, but add in the infection, and it can become a "hot" gallbladder, and that becomes an emergent procedure. It is much better for mother and fetus to have an elective procedure where you have everyone there that you need, not at a 2 am emergency where you are hustling to get things stabilized.

[z's playa]

Fatty foods like milk cause the bile duct to constrict, which in turn causes pain.

Thanks Tweety. :)

Z

[kmchugh]

Breezy

The real question is what is the highest risk path your friend could follow? In the end, that's between her, her OB, and her surgeon. There are some things to think about, though. The greatest risk would be a ruptured or gangrenous gallbladder. While the Vicoden may be helping her with the pain at night, it is doing nothing for her cholecystitis, and isn't helping the baby, either. Since she is only taking one a night for pain that really exists, addiction (on her part) is a pretty remote possibility. On the other hand, the potential for giving birth to an addicted baby is much higher. So, that's a definite strike against her current actions.

Worse, however, are the potential complications of the ongoing infection. There is the potential for the gallbladder to rupture or become gangrenous. Both can lead to peritonitis, which is definitely not good for the baby. Think very high possibility of early delivery or miscarriage. Infection itself increases the risk of miscarriage. It just is not a good state for a parturient to be in.

All these risks are counterbalanced by the risks attendant to general anesthesia in the pregnant woman. I have done a number of anesthetics for pregnant women, including a few gallbladders. It's not something to be undertaken lightly, and the risks must be weighed against the risks of not having surgery. The greatest risk of general anesthesia in pregnancy seem to be in the first trimester, which your friend has passed. Yes, general anesthesia in the pregnant population does carry a risk of induction of labor, but so does infection, peritonitis, and every other potential complication your friend faces if her gallbladder becomes gangrenous or ruptures.

It is entirely possible for your friend to finish her pregnancy without further complication. However. from what you describe, it sounds as though her risk is increasing. Then she must consider, would she rather have a scheduled surgery, under known and controlled conditions, or would she rather have to have emergent surgery, with the additional complicating factors of sepsis, peritonitis, and everything that goes with that? (By the way, in most cases of peritonitis or rupture, the option for laparoscopic surgery goes by the boards. The surgery becomes an open cholecystectomy, a much more painful surgery, and one that is riskier for both her and her pregnancy.)

Just from what you write, it sounds as though your friend doesn't really have any options. I would guess that is what her surgeon has told her, but she doesn't want to face it yet. Tell her not to wait too long.

Kevin McHugh

[Tweety, BSN, RN]

I thought the poster was saying the infection was in the gallbladder?

That's what I'm taking it as. By why would any MD recommend sitting on it? So I just wanted clarification.

[SmilingBluEyes]

Vicodin or surgery???? The ones who say this is between her OB and her are right....However, were it me......

Well, with the ones who say surgery, I agree. The rupture of a gall bladder/duct is not pretty. Nor is the potential for infection/peritonitis.

......Nor is exposing the fetus to vicodin for the next 3 or 4 months in pregnancy. babies exposed that much and for that long often need to be watched in a special care nursery/NICU and given drugs to wean them off the narcs. She will likely need a LOT of Vicodin to ward off the horrendous pain she is experiencing. This will all go the baby in pregnancy....

Babies exposed to narcs in pregnancy (narcs taken often/routinely) are also placed on seizure precautions, yep it's that serious.

I would opt for SURGERY based on this alone.

[BittyBabyGrower, MSN, RN]

Taking Vicodin for the rest of the pregnancy...not a good idea! I do know that Vicodin can increase intracranial pressure and isn't used in head traumas, so I wonder if it would have the same effect on the fetus? Also, that is going to be one very sleepy baby who will most likely need intubated right after birth and for a while after...we have had severely addicted kids need to be vented just for sedation purposes due to the risk of seizures and aspiration. An addicted baby is no fun....it will have to stay in the hospital until it is weaned off of narcotics, and they are NOT fun babies in any way shape or form. She needs to discuss this with her OB....I am thinking he is going to tell her it isn't a good idea. She will be at high risk for preemie labor anyways if she has an infection going or that GB bursts.

[breezy5]

i just got an update from my friend, and she talked to both the OB and surgeon. The surgeon said to have the surgery and when asked if he has ever done this surgery on a pregnant women he said "no but it is a routine surgery." The OB stated he does not think she should have surgery because of the risks of premature birth, nicking the sac etc. Stated the vicodin should not impact the fetus that much (i dont see how it wouldnt though). I dont think she is planning on surgery.

To answer some questions::

THe infection is in the gallbladder and kidney and she is on 2 antibiotics.

She tries not to take the vicodin, but often needs it at night.

One doc told her to just eat vegetables so she dont become ill and vomit.

She eats as tolerated, usually any fattier foods is at night (probally why she needs the vicodin more at night)

thank you for your responses

[z's playa]

One doc told her to just eat vegetables so she dont become ill and vomit.

Dr obviously doesn't know the obvious nutritional requirements for a mommy and her fetus.

ONLY veggies?

tsk tsk.

Z

[Marie_LPN, RN, LPN, RN]

THe infection is in the gallbladder and kidney and she is on 2 antibiotics.

She needs a second opinion from ANOTHER OB, preferably not somoene in the same group as the one she's seeing now.

[SmilingBluEyes]

I am finding this all a bit incredible.