Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

Abstract

Background: Diagnosis and management of non-obstetric abdominal pathologies during pregnancy are clinically challenging for both obstetricians and general surgeons. Our aim was to evaluate the outcome of pregnant patients who had undergone non-obstetric abdominal surgery. Methods: We retrospectively reviewed 76 pregnant patients who had required surgery for non-obstetric abdominal pathologies during pregnancy at our department from January 2005 to December 2015. Data were collected retrospectively from medical records as well as from our institutional perinatal database. We evaluated data for clinical presentation, perioperative management, preterm labor, and maternal and fetal outcomes. Results: The patients' mean age was 29 (interquartile range IQR 25-33) years. Indications for surgery were acute appendicitis in 63%, adnexal pathology in 11%, cholecystolithiasis in 5% and other indications in 21%; surgery was performed in an elective setting in 18% and in an emergent/urgent setting in 82%. In five cases, complications, three of them oncological, called for further surgery. Ninety-seven percent of operations were conducted under general anesthesia. Median skin-to-skin time was 50 (37-80) minutes, median in-hospital stay was 4 (3.5-6) days, and 5 % required postoperative intensive care. Preterm labor occurred in 15%, miscarriage in 7% (none of them directly related to abdominal surgery). Conclusion: Abdominal surgery for non-obstetric pathology during pregnancy can be performed safely, if mandatory, without increases in maternal and fetal pathology, miscarriage, and preterm birth rates.

Prediction of Spontaneous Preterm Birth : Clinical and Immunological Aspects

“…Regarding maternal characteristics there was, as expected, a significant difference (p<0.001) in gestational age at delivery comparing cases (median w 32 (range 23-34)) and controls (w40 (37)(38)(39)(40)(41)(42)). The median gestational age at first trimester sampling was 10+4 weeks (range 7+1-16+3) and at second trimester sampling 25+3 weeks (range 23+2-30+3).…”

“…Other matters of importance are if conception was achieved by assisted reproductive technique; genitourinary or extragenital infections afflicting the pregnant woman; active periodontal disease during pregnancy 6,30 ; and polyhydramnios 36 . Interestingly, non-obstetric surgical interventions during pregnancy, both intraabdominal and others, also seem to pose a risk for sPTB later in pregnancy, with a rate varying between different studies (15-41%) [37][38][39] .…”

Sonografisch assistierte venöse Thrombektomie im ersten Trimenon – ein Fallbericht

“…Grundsätzlich ist bei Thrombosen während einer Schwangerschaft immer zwischen dem mütterlichen und dem kindlichen Risiko zu differenzieren. Das durch eine Narkose bestehende Risiko scheint nicht mit einem schlechteren Outcome für Mutter und Kind verbunden zu sein und ist v. a. durch Erfahrungen im Rahmen von Appendektomien empirisch analysiert worden [1][2][3]. Neben den allgemeinen Risiken der Operation wie Wundheilungsstörung, Infekt, Blutung oder Verletzung von Begleitstrukturen liegt das Hauptrisiko in der Diagnostik und Therapie bei schwangerschaftsassoziierten Thrombosen in der maternen und fetalen Belastung durch die Röntgenstrahlung.…”

Do Small Incisions Need Only Minimal Anesthesia?—Anesthetic Management in Laparoscopic and Robotic Surgery

“…It is not uncommon for pregnant women to need abdominal surgery that is not related to obstetrics. Mostly, these procedures are appendectomy or cholecystectomy, which are usually managed in laparoscopic technique [ 70 ]. There is sufficient evidence for the advantages of laparoscopic technique over open procedures in non-pregnant women [ 71 ].…”