Antepartum nonobstetrical surgery at ≥23 weeks’ gestation and risk for preterm delivery

Baldwin, Elizabeth A.; Borowski, Kristi S.; Brost, Brian C.; Rose, Carl H.

doi:10.1016/j.ajog.2014.09.001

Cited by 23 publications

(27 citation statements)

References 10 publications

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“…Asides from abortion and preterm delivery, we also found increased risks of cesarean section and long hospital stays. These were similar to previous reports [ 16 , 21 , 22 ]. Taken together, increased abortion, preterm delivery, cesarean section rate and longer in-patient stay are the common and most reliable findings in the existing literature.…”

Section: Discussionsupporting

confidence: 93%

Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan

Weng

et al. 2018

BMC Pregnancy Childbirth

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BackgroundWhether nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion or adverse delivery outcomes is still unclear.MethodsWe performed a retrospective case-control study using a Longitudinal Health Insurance Database (LHID 2000) containing claim-data of 1 million randomly selected beneficiaries. We compared the incidences and estimated the adjusted odds ratios (aOR) with 95% confidence interval (95% CI) for spontaneous abortion, adverse delivery outcomes, cesarean delivery, and prolonged hospital stay to determine the risk of adverse outcomes in women who had nonobstetric surgery during gestation as compared to those who did not have any surgery during gestation.ResultsAfter exclusion, we were left with 114,852 delivery and 3999 abortion cases in our study; and 462 (0.39%) of them had nonobstetric surgery under general or regional anesthesia during pregnancy. The leading surgeries were repair of cervical os (33.12%), appendectomy (17.32%), ovarian surgeries (13.64%), and fixation of fractured bone (8.01%).The risk of spontaneous abortion (4.23% vs. 2.43%, aOR:1.53; 95% CI: 1.01–2.31), antepartum hemorrhage (7.14% vs. 2.83%, aOR: 2.51; 95% CI: 1.74–3.61), pre-eclampsia/eclampsia (2.60% vs. 1.01%, aOR: 2.35; 95% CI: 1.30–4.23), gestational diabetes (2.38% vs. 0.69%, aOR: 3.12; 95% CI: 1.69–5.78), prematurity (9.06 vs. 4.90%, aOR: 3.31; 95% CI: 2.54–4.31), cesarean section (43.55% vs. 33.76%, aOR: 1.41; 95% CI: 1.17–1.71), and prolonged hospital stay (1.82% vs. 5.91%, aOR: 3.23; 95% CI: 2.16–4.83) were higher in those women who had nonobstetric surgery after adjusting for age and comorbidities.ConclusionsNonobstetric surgery during gestation were associated with a higher risk of spontaneous abortion, adverse delivery outcomes, cesarean section, and prolonged hospital stay.

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Section: Discussionsupporting

confidence: 93%

Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan

Weng

et al. 2018

BMC Pregnancy Childbirth

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“…The majority of general anesthetics are lipophilic and can easily cross the placental barrier. About 0.5% to 2% of pregnant women will suffer non-obstetric surgery [ 3 – 5 ], and most of these procedures (up to 73%) must be completed under general anesthesia [ 6 ]. More than 75,000 pregnant women in the United States and 5,700 to 7,600 pregnant women in the European Union undergo non-obstetric surgery each year [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Maternal Exposure of Rats to Isoflurane during Late Pregnancy Impairs Spatial Learning and Memory in the Offspring by Up-Regulating the Expression of Histone Deacetylase 2

et al. 2016

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Increasing evidence indicates that most general anesthetics can harm developing neurons and induce cognitive dysfunction in a dose- and time-dependent manner. Histone deacetylase 2 (HDAC2) has been implicated in synaptic plasticity and learning and memory. Our previous results showed that maternal exposure to general anesthetics during late pregnancy impaired the offspring’s learning and memory, but the role of HDAC2 in it is not known yet. In the present study, pregnant rats were exposed to 1.5% isoflurane in 100% oxygen for 2, 4 or 8 hours or to 100% oxygen only for 8 hours on gestation day 18 (E18). The offspring born to each rat were randomly subdivided into 2 subgroups. Thirty days after birth, the Morris water maze (MWM) was used to assess learning and memory in the offspring. Two hours before each MWM trial, an HDAC inhibitor (SAHA) was given to the offspring in one subgroup, whereas a control solvent was given to those in the other subgroup. The results showed that maternal exposure to isoflurane impaired learning and memory of the offspring, impaired the structure of the hippocampus, increased HDAC2 mRNA and downregulated cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) mRNA, N-methyl-D-aspartate receptor 2 subunit B (NR2B) mRNA and NR2B protein in the hippocampus. These changes were proportional to the duration of the maternal exposure to isoflurane and were reversed by SAHA. These results suggest that exposure to isoflurane during late pregnancy can damage the learning and memory of the offspring rats via the HDAC2-CREB -NR2B pathway. This effect can be reversed by HDAC2 inhibition.

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“…[5][6][7] Planning for such an event is a critical element in the care of the seriously ill gravid woman. 8,9 …”

Section: Discussionmentioning

confidence: 98%

Fetal Heart Rate Monitoring During Surgical Correction of Spontaneous Pneumothorax During Pregnancy

Wilson

Burt²,

Baker³

et al. 2016

Obstetrics &Amp; Gynecology

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Antepartum nonobstetrical surgery at ≥23 weeks’ gestation and risk for preterm delivery

Cited by 23 publications

References 10 publications

Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan

Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan

Maternal Exposure of Rats to Isoflurane during Late Pregnancy Impairs Spatial Learning and Memory in the Offspring by Up-Regulating the Expression of Histone Deacetylase 2

Fetal Heart Rate Monitoring During Surgical Correction of Spontaneous Pneumothorax During Pregnancy

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