Pregnancy outcome following non-obstetric surgical intervention.
OBJECTIVE
To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome.


METHODS
A systematic review of all English language literature.


RESULTS
Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%).


CONCLUSIONS
Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.
Cohen-Kerem
Raanan
R
Motherisk Program, Division of Clinical Pharmacology and Toxicology, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
Railton
Craig
C
Oren
Dana
D
Lishner
Michael
M
Koren
Gideon
G
D001062:Appendectomy / Q000009:adverse effects; D000013:Congenital Abnormalities / Q000453:epidemiology; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000601:surgery*; D011256:Pregnancy Outcome; D012306:Risk; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000401:mortality