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

Abstract

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.

Association of appendectomy for acute appendicitis in pregnancy with adverse obstetrical outcomes

“…Appendectomy is one of the most common nonobstetric surgeries during pregnancy, and it increases the risk of adverse obstetrical outcomes such as miscarriage and preterm birth [10]. This study found that symptom duration and anorexia were independent risk factors for miscarriage or preterm birth.…”

Current approaches to treating acute appendicitis in the third trimester

“… 7 11 Historically, OA is used more frequently in the third trimester, influenced by concern for iatrogenic injury, loss of domain and risk of preterm birth. 4 14 16 17 Considering LA is more commonly administered in the first trimester, 16 during which fetal loss rates are inherently higher regardless of appendicitis, 18 the causal relationship between fetal demise and the condition is confounded. Recent publications have shown equivalent maternal and fetal outcomes for LA and OA.…”

Laparoscopic Surgery During Pregnancy: A Meta-Review and Quality Analysis Using the Assessment of Multiple Systematic Reviews (AMSTAR) 2 Instrument

“…or because the full text could not be retrieved after searching thoroughly through several libraries and attempting to contact the authors (Appendix B). Eventually, we included 33 articles in our meta-review, 18 SR-only [ 13 - 30 ] and 15 SRs with MA [ 31 - 45 ]. Among them, 23 articles contained non-case report/ non-case series NRSIs or RCTs and were subsequently evaluated with the AMSTAR 2 instrument [ 13 - 16 , 18 - 20 , 30 - 45 ].…”

“…Eventually, we included 33 articles in our meta-review, 18 SR-only [ 13 - 30 ] and 15 SRs with MA [ 31 - 45 ]. Among them, 23 articles contained non-case report/ non-case series NRSIs or RCTs and were subsequently evaluated with the AMSTAR 2 instrument [ 13 - 16 , 18 - 20 , 30 - 45 ]. Figure 1 illustrates the flowchart of study selection.…”

“…Based on their discipline, the studies were classified as follows, in descending order: LA 10 studies (30.3%) [ 13 , 14 , 31 - 38 ], laparoscopic cerclage for cervical insufficiency eight studies (24.2%) [ 15 - 19 , 39 - 41 ], adnexal-ovarian laparoscopic surgery five studies (15.2%) [ 20 , 21 , 42 - 44 ], laparoscopic cholecystectomy and biliary tree exploration three studies (9.1%) [ 22 , 23 , 45 ], laparoscopic myomectomy two studies (6.1%) [ 24 , 25 ], and one each for laparoscopic surgery regarding pancreatic indications [ 28 ], adrenal indications [ 26 ], and bariatric complications (3.0%) [ 27 ]. Two studies were interdisciplinary, one examining robotic-assisted laparoscopic surgery during pregnancy for any indication [ 29 ], and one investigating non-obstetric surgery during pregnancy in general [ 30 ]. Figure 4 summarizes the distribution of the included studies by discipline.…”