Evaluation of safety and foeto‐maternal outcome following non‐obstetric surgery in pregnancy: a retrospective single‐site Australian study

Choi, Ho Nam; Ng, Bertrand; Arafat, Yasser; Mendis, Balapuwaduge A S; Dharmawardhane, Anoj; Lucky, Tarana

doi:10.1111/ans.16617

Cited by 5 publications

(21 citation statements)

References 25 publications

(25 reference statements)

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“…In the UK study, nonobstetric surgery during the third trimester increased the risk for preterm delivery 2 . Similar trend was seen in the present study but not in the Australian study 10 …”

Section: Discussionsupporting

confidence: 89%

“…Before the guideline, elective surgery was performed especially during the first trimester, but after the guideline and the first revision, the distribution was quite even between the trimesters. Similar findings have been reported from a single Australian centre 10 . In a study by Choi et al 10 during 2009–2018, a total of 108 cases of nonobstetric surgery in pregnant women were performed, of which 45% were during the first trimester.…”

Section: Discussionsupporting

confidence: 82%

“…Similar findings have been reported from a single Australian centre. 10 In a study by Choi et al 10 during 2009-2018, a total of 108 cases of nonobstetric surgery in pregnant women were performed, of which 45% were during the first trimester. Possibly patient's unawareness of pregnancy onset may have influenced a relatively high proportion of surgeries performed during the first trimester.…”

Section: Discussionmentioning

confidence: 99%

“…2 Similar trend was seen in the present study but not in the Australian study. 10 Some studies have evaluated the optimal timing of elective surgery during pregnancy. One of the most common indications for surgery during pregnancy is the occurrence of asymptomatic ovarian tumours or cysts; in the present study, ovarian surgery was the third most common surgical indication.…”

Section: Discussionmentioning

confidence: 99%

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Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Haataja

Gissler

Kokki

et al. 2022

Repro Female Child Health

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To assess how much and on which specialities nonobstetric surgery was performed for pregnant women in Finland during a 21-year period, between 1997 and 2017 and the effect of Finnish guideline about preoperative evaluation affected the amount of surgery during pregnancy. Design: Register-based observational study. Setting: Finnish Medical Birth Register. Population: 1 175 677 pregnancies ending with a singleton birth 1997−2017. Methods: Amount of nonobstetric surgeries, and pregnancy foetal and maternal outcomes in Finland between 1997 and 2017 were searched. Main Outcome Measures: The prevalence of nonobstetric surgery, and proportions of elective and emergency nonobstetric surgery performed during the three trimesters. Results: The prevalence of nonobstetric surgery before the guideline was 0.39%, after the guideline 0.28% and after the first revision 0.39%. The prevalence of elective surgery decreased after the guideline (before 0.15%, after the guideline 0.10% and 0.07% after the first revision), but the prevalence of emergency surgery was highest after the first revision (0.24%, 0.21% and 0.29%). The guideline and the first revision had no impact on the timing of elective surgery; 35% of elective surgery was performed during the second trimester before the guideline, 36% after it and 36% after its first revision. The preterm delivery rate, 9.1%−9.4% of pregnancies with nonobstetric surgery was twofold higher than that of pregnancies without surgery. Conclusion:The prevalence of nonobstetric surgery during pregnancy is low in Finland. The national guideline decreases the prevalence of elective surgery during pregnancy but does not impact the timing of nonobstetric surgery.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Haataja

Gissler

Kokki

et al. 2022

Repro Female Child Health

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“…Non-obstetric surgery in general. Pregnancy outcomes after surgeries falling under different specialties were evaluated in 10 retrospective studies, 11,12,16,21,25,29,35,43,44,60 There were data on 57,949 pregnancies where non-obstetric surgery was performed (prevalence 0.4%). Half of the procedures (52%) were scheduled, and half were emergency procedures (48%).…”

Section: Description Of the Studies According To The Type Of Surgerymentioning

confidence: 99%

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review

et al. 2023

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Background and objective: Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes. Methods: A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates. Results: We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0). Conclusions: The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.

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General anaesthesia for nonobstetric surgery during pregnancy

Bleeser

Vally

Velde

et al. 2022

European Journal of Anaesthesiology Intensive Care

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Nonobstetric surgery may be required in up to 1% of pregnancies. Most common procedures are urgent abdominal surgeries requiring general anaesthesia. Maintaining normal maternal physiology during anaesthesia is vital. Left lateral tilt position prevents aortocaval compression and preserves normal venous return. Preparation for a difficult airway is required in all obstetric patients due to the known anatomical and physiological changes. Aspiration prophylaxis and a rapid sequence induction are traditionally recommended to avoid the (probably overestimated) risk of aspiration. Although the minimum alveolar concentration (MAC) of volatile anaesthetic agents is reduced by 30 to 40%, awareness occurs more frequently in the obstetric population. Maternal outcomes from surgery are comparable with those of nonpregnant women, but increased incidences of foetal loss, preterm delivery, low birth weight and caesarean section have been reported. Although animal studies have observed impaired foetal brain development after antenatal exposure to anaesthesia, the translational value of these studies remain controversial. Clinical evidence is nearly absent. Withholding urgent/essential procedures is certainly more threatening than proceeding with the surgery. To increase the safety of mother and foetus, nonurgent or nonessential procedures should be postponed until after delivery, and if procedures cannot wait, locoregional anaesthesia should be used if possible. Where general anaesthesia cannot be avoided, the duration of exposure should be kept to a minimum. This narrative review summarises the literature of the past 20 years concerning the anaesthetic management and outcomes of nonobstetric surgery under general anaesthesia during pregnancy.

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Evaluation of safety and foeto‐maternal outcome following non‐obstetric surgery in pregnancy: a retrospective single‐site Australian study

Cited by 5 publications

References 25 publications

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review

General anaesthesia for nonobstetric surgery during pregnancy

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