Abdominal Surgery Can Be Undertaken Safely During Pregnancy

A new study concludes that abdominal surgery for non-obstetric pathology can be performed safely during pregnancy (if needed) without increase in maternal and fetal pathology, miscarriage, and preterm birth rates.

Researchers at the Medical University of Graz (Austria) conducted a retrospective analysis of 76 pregnant patients (mean age 29 years) who required surgery for non-obstetric abdominal pathologies during pregnancy from January 2005 to December 2015. Retrospective data were collected from medical records and a perinatal database. Indications for surgery were acute appendicitis in 63%, adnexal pathology in 11%, cholecystolithiasis in 5%, and other indications in 21%. The researchers then evaluated data for clinical presentation, perioperative management, preterm labor, and maternal and fetal outcomes.

The results revealed that abdominal surgery was performed in an elective setting in 18% of the women, and in an emergent or urgent setting in 82%, with 97% of the procedures conducted under general anesthesia. In five cases, complications, three of them oncological, required further surgery. The median skin-to-skin time was 50 minutes, median in-hospital stay was four days, and 5% required postoperative intensive care. In addition, preterm labor occurred in 15% of the pregnancies and miscarriage in 7%, but none of them were directly related to abdominal surgery. The study was published on October 25, 2019, in BMC Pregnancy and Childbirth.

“Diagnosis and management of non-obstetric abdominal pathologies during pregnancy are clinically challenging for both obstetricians and general surgeons,” concluded senior author Peter Kornprat, MD, and colleagues. “Our study indicates that abdominal surgery for non-obstetric pathology during pregnancy can be performed safely whenever indicated, without adverse obstetric outcome for either mother or fetus.”

The most frequent indications for surgery during pregnancy are infections, such as acute appendicitis and cholecystitis, ovarian disorders and bowel obstruction, or traumatological or oncological indications. There are no clear recommendations as to when or if laparoscopy or open surgery should be used. IN addition, interdisciplinary management is needed for maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth.

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Medical University of Graz