Background: Sugammadex is widely used to effectively and rapidly reverse neuromuscular blockade. However, its potential binding to progesterone and theoretical risk of preterm labor and fetal anomalies has raised concerns about its use in pregnancy. A 2019 Society for Obstetric Anesthesia and Perinatology statement recommended avoiding sugammadex in patients undergoing surgery during pregnancy. However, there is limited and conflicting data regarding the safety of sugammadex in pregnancy. We conducted a retrospective study to evaluate our hypothesis that there would be no differences in observed obstetric, maternal, or fetal outcomes in pregnant patients who underwent nonobstetric surgery and received sugammadex or neostigmine for neuromuscular blockade reversal.

Methods: This retrospective cohort study included pregnant patients who underwent nonobstetric surgeries in our hospital system between October 1, 2016 and December 31, 2023. Patients were categorized based on neuromuscular blockade reversal (sugammadex or neostigmine). Demographic, anesthetic, surgical, and obstetric characteristics were collected. The primary aim was to assess the prevalence of preterm labor and pregnancy loss in patients who received sugammadex vs neostigmine. Secondary aims assessed the prevalence of sugammadex use, residual neuromuscular blockade, and postoperative nausea and vomiting (PONV).

Results: The study included 101 nonobstetric surgeries performed on 100 pregnant women during 100 pregnancies: sugammadex was used in 20 (20%) of procedures and neostigmine was used in 81 (80%) of procedures. Demographic and obstetric characteristics were similar between groups. Preterm labor occurred in 10/100 (10%) pregnancies (1/20 [5%] sugammadex vs 9/80 [11.2%] neostigmine). Premature rupture of membranes occurred in 5/100 (5%) pregnancies (1/20 [5%] sugammadex vs 4/80 [5%] neostigmine). There were no maternal or fetal deaths, new fetal anomalies, or residual neuromuscular blockade observed in either group. PONV occurred in 17 patients (21%) exposed to neostigmine and 2 patients (10%) exposed to sugammadex. Two postoperative complications occurred in the neostigmine group. The first (G1P0, 32+4 weeks) developed post-extubation hypoxic respiratory failure requiring reintubation and ICU admission. The second (G1P0, 31+5 weeks) developed postoperative tachypnea and tachycardia requiring ICU admission. No postoperative complications were observed with sugammadex. Additional outcomes are listed in Table 1.

Conclusions: We describe the successful use of sugammadex in pregnancy for nonobstetric surgeries. Although conclusions regarding safety cannot be drawn from our small, retrospective analysis, no adverse maternal/fetal events were observed. Our findings add to the limited but growing evidence supporting the reevaluation of sugammadex use in pregnancy.