Safety and Timing of Nonobstetric Abdominal Surgery in Pregnancy

Abstract

Background/Aims: Abdominal disorders occurring during pregnancy pose special difficulties in diagnosis and management to the obstetrician and surgeon. The advisability of nonobstetric abdominal surgery during pregnancy is uncertain. Our objective was to evaluate the safety and timing of abdominal surgery during pregnancy. Methods: We retrospectively reviewed 77 consecutive gravid patients undergoing nonobstetric abdominal surgery from 1989 to 1996 at an urban academic medical center and a large affiliated community teaching hospital. Medical records were evaluated for clinical presentation, perioperative management, preterm labor, and maternal and fetal morbidity and mortality. Results: The rate of nonobstetric abdominal surgery during pregnancy was 1 in every 527 births. Among the 77 patients, the indications for surgery were adnexal mass (42%), acute appendicitis (21%), gallstone disease (17%) and other (21%). There was no maternal or fetal loss or identifiable neonatal birth defect. Preterm labor occurred in 26% of the second-trimester patients and 82% of the third-trimester patients. Preterm labor was most common in patients with appendicitis and after adnexal surgery. Preterm delivery occurred in 16% of the patients, but appeared to be directly related to the abdominal surgery in only 5%. Conclusion: Surgery during the first or second trimester is not associated with significant preterm labor, fetal loss or risk of teratogenicity. Surgery during the third trimester is associated with preterm labor, but not fetal loss.

Laparoscopic management of appendicitis and symptomatic cholelithiasis during pregnancy

“…In that study, surgery decreased the number of days in hospital and even reduced the rate of labor induction and preterm deliveries [42]. The nonsurgical management led to suboptimal clinical outcome in up to 38% of the women [42,43]. That study clearly argues in favor of changing the management of gallstone disease during pregnancy from conservative or open cholecystectomy toward early laparoscopic cholecystectomy.…”

Clinical Risk Factors for Preterm Birth

“…The risk and benefits of treating the surgical condition must be weighed up against the risk of adverse pregnancy outcomes, including pregnancy loss and preterm delivery. Abdominal surgery during the first and second trimester of pregnancy is not associated with a significant preterm birth risk, but this risk becomes of significance in the third trimester of pregnancy (Visser, et al, 2001). A short inter-pregnancy interval appears to be a risk factor for adverse perinatal outcomes, including preterm birth.…”

Perforated Duodenal Ulcer –A Rare Cause of Acute Abdomen in Pregnancy

“…The nonobstetric abdominal surgery in pregnancy increases incidence of preterm labour in second and third-trimester patients and reported as 26% and 82% respectively [10]. Hence prophylactic steroid administration should be considered in patients who are for surgical intervention at preterm gestation.…”