Abdominopelvic Surgery Risks in Pregnancy Vary by Gestational Age, Indication

By Reuters Staff

January 18, 2022

NEW YORK (Reuters Health) - Abdominopelvic surgery for non-obstetric reasons is often necessary during pregnancy and the risk of harm to the fetus varies by gestational age, indication and acuity, according to a large meta-analysis.

The analysis included 114 observational studies with more than 67,000 pregnant women undergoing non-obstetric abdominopelvic surgery, including appendectomy (52 studies), adnexal (34 studies), cholecystectomy (eight) and mixed surgery types (20).

Overall pooled proportions of fetal loss, preterm birth and maternal mortality were 2.8%, 9.7% and 0.04%, respectively.

"Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (e.g. appendectomy, adnexal torsion) than for abdominal or non-urgent conditions (e.g. cholecystectomy, adnexal mass," the study team reports in Annals of Surgery.

"Surgery in the second and third trimester was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimester (fetal loss 2.9%, preterm birth 5.6%)," they say.

"This is the most comprehensive systematic review and meta-analysis of adverse fetal and maternal outcomes following non-obstetric abdominopelvic surgery to date," note Dr. Maria Cusimano of the University of Toronto, Canada, and colleagues.

"Our pooled estimates identify clinical scenarios with the highest risk of adverse fetal outcomes following surgery; while we are unable to provide specific management recommendations due to the nature and quality of studies identified, these data may help multidisciplinary teams tailor mitigation strategies," they write.

These strategies may include use of tocolytics and/or corticosteroids perioperatively; consideration of pre-emptive elective surgery (e.g. for adnexal masses at substantial risk of torsion); and deferral of surgery to the second trimester when safely possible, the researchers say.

SOURCE: https://bit.ly/31wm4fs Annals of Surgery, online December 28, 2021.