Pregnancy and Hernia

Abdominal wall hernias can occur in pregnancy as a result of increased intraabdominal pressure and tension on the abdominal wall. Symptoms include pain, nausea, vomiting, abdominal distention, and absence of flatus and stool. Physical exam findings may include a palpable lump or defect that may or may not be reducible, prior incisional scars, and skin erythema or tenderness. Ultrasound may be used to further confirm the diagnosis. Pregnant patients with evidence of bowel incarceration, strangulation, perforation, or an irreducible umbilical hernia should have urgent surgery for hernia repair via open or laparoscopic approach. For non-emergent hernias, elective repair via open or laparoscopic approach, with or without mesh, should be considered in pregnant patients and women of child-bearing age with consideration for gestational age, likelihood of recurrence, and potential for incarceration during pregnancy. Further prospective studies are needed to determine best practice for treatment of hernias during pregnancy.