• Maria C Cusimano, Jessica Liu, Paymon Azizi, Jonathan Zipursky, Katrina Sajewycz, Jess Sussman, Teruko Kishibe, Eric Wong, Sarah E Ferguson, Rohan D'Souza, and Nancy N Baxter.
• Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada.
• Ann. Surg. 2023 Jul 1; 278 (1): e147e157e147-e157.

ObjectiveTo quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy.Summary Background DataSurgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking.MethodsWe systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link.ResultsWe identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters 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 trimesters (fetal loss 2.9%, preterm birth 5.6%).ConclusionsAbsolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

20 keywords...

hide…