Reproductive outcomes after pregnancy complicated by maternal-fetal surgery.
OBJECTIVE
The reproductive outcomes for women after the pregnancy complicated by maternal-fetal surgery were evaluated to obtain evidence-based information for prenatal risk counseling.


METHODS
The retrospective review identified 83 women with maternal-fetal surgery from a single institution (1996-2002). These women were sent a consent form and a questionnaire to document postoperative problems, fertility, obstetric outcomes, and psychosocial concerns in pregnancy after the index fetal therapy. Institutional Review Board approval was obtained from Committee for Protection of Human Subjects.


RESULTS
The total return rate was 55 (66%). The pregnancy rate was 62% (18% spontaneous abortion, 24% preterm delivery, and 58% term delivery). Complications were reported in 12 of 34 pregnancies (35%), including uterine dehiscence/rupture (12%/6%), cesarean hysterectomy (3%), and antepartum hemorrhage requiring transfusion (9%).


CONCLUSIONS
The reproductive outcome of uterine dehiscence, rupture, and hysterectomy was 12%, 6%, and 3%, respectively, after a pregnancy complicated by maternal-fetal surgery. The uterine rupture rate is similar to the rupture rate after "classical" cesarean section (4%-9%).
Wilson
R Douglas
RD
Pediatric Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Johnson
Mark P
MP
Flake
Alan W
AW
Crombleholme
Timothy M
TM
Hedrick
Holly L
HL
Wilson
Jordan
J
Adzick
N Scott
NS
D005260:Female; D005315:Fetal Diseases / Q000196:embryology*; D005333:Fetus / Q000601:surgery*; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D015160:Hydrops Fetalis / Q000601:surgery; D020883:Hysterotomy; D008591:Meningomyelocele / Q000196:embryology / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D012189:Retrospective Studies; D012445:Sacrococcygeal Region; D013529:Surgical Wound Dehiscence; D013724:Teratoma / Q000601:surgery; D014597:Uterine Rupture / Q000209:etiology