Fetal Risk of Anesthesia and Surgery during Pregnancy

Duncan, Peter G.; Pope, W. D. B.; Greer, Nancy

doi:10.1097/00000542-198606000-00019

Cited by 297 publications

(85 citation statements)

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“…Duncan et al 2 found an even higher RR (1.58) of abortion associated with a general anaesthetic in their 1986 Canadian study of 2565 pregnant women. Our study is much larger and more recent, perhaps reflecting improvements in surgery, but (like Duncan et al's 2 study) is unable to dissociate the risk of surgery from the risk of anaesthesia or the underlying condition for which the procedure was carried out.…”

Section: Spontaneous Abortion Associated With Hospitalisation and Prementioning

confidence: 90%

“…2 Patients were matched to controls by age and geographical area. There was no statistically increased risk of fetal loss among the group as a whole.…”

Section: Previous Literaturementioning

confidence: 99%

“…The studies are also, in general, poorly controlled and have conflicting results regarding the risk of surgery. Duncan et al 2 suggest that surgery is associated with an increased risk of fetal loss (including miscarriage), and the Swedish studies 4,5 suggest that there is no increase in stillbirth but that there is an increase in prematurity and early neonatal death, particularly in the case of appendectomy. Furthermore, although it is clear from the data on appendectomy that the risk to the fetus when a pregnant woman undergoes surgery is not uniform, there have been few attempts to quantify the risk by other types of surgery.…”

Section: Previous Literaturementioning

confidence: 99%

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Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Aylin

Bennett

Bottle

et al. 2016

Health Serv Deliv Res

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Background: Previous research suggests that non-obstetric surgery is carried out in 1 – 2% of all pregnancies. However, there is limited evidence quantifying the associated risks. Furthermore, of the evidence available, none relates directly to outcomes in the UK, and there are no current NHS guidelines regarding non-obstetric surgery in pregnant women. Objectives: To estimate the risk of adverse birth outcomes of pregnancies in which non-obstetric surgery was or was not carried out. To further analyse common procedure groups. Data Source: Hospital Episode Statistics (HES) maternity data collected between 2002 – 3 and 2011 – 12. Main outcomes: Spontaneous abortion, preterm delivery, maternal death, caesarean delivery, long inpatient stay, stillbirth and low birthweight. Methods: We utilised HES, an administrative database that includes records of all patient admissions and day cases in all English NHS hospitals. We analysed HES maternity data collected between 2002 – 3 and 2011 – 12, and identified pregnancies in which non-obstetric surgery was carried out. We used logistic regression models to determine the adjusted relative risk and attributable risk of non-obstetric surgical procedures for adverse birth outcomes and the number needed to harm. Results: We identified 6,486,280 pregnancies, in 47,628 of which non-obstetric surgery was carried out. In comparison with pregnancies in which surgery was not carried out, we found that non-obstetric surgery was associated with a higher risk of adverse birth outcomes, although the attributable risk was generally low. We estimated that for every 287 pregnancies in which a surgical operation was carried out there was one additional stillbirth; for every 31 operations there was one additional preterm delivery; for every 25 operations there was one additional caesarean section; for every 50 operations there was one additional long inpatient stay; and for every 39 operations there was one additional low-birthweight baby. Limitations: We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Many spontaneous abortions will not be associated with a hospital admission and, therefore, will not be included in our analysis. A spontaneous abortion may be more likely to be reported if it occurs during the same hospital admission as the procedure, and this could account for the associated increased risk with surgery during pregnancy. There are missing values of key data items to determine parity, gestational age, birthweight and stillbirth. Conclusions: This is the first study to report the risk of adverse birth outcomes following non-obstetric surgery during pregnancy across NHS hospitals in England. We have no means of disentangling the effect of the surgery from the effect of the underlying condition itself. Our observational study can never attribute a causal relationship between surgery and adverse birth outcomes, and we were unable to determine the risk of not undergoing surgery where surgery was clinically indicated. We have...

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Section: Spontaneous Abortion Associated With Hospitalisation and Prementioning

confidence: 90%

“…2 Patients were matched to controls by age and geographical area. There was no statistically increased risk of fetal loss among the group as a whole.…”

Section: Previous Literaturementioning

confidence: 99%

Section: Previous Literaturementioning

confidence: 99%

See 1 more Smart Citation

Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Aylin

Bennett

Bottle

et al. 2016

Health Serv Deliv Res

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show abstract

“…Historically, general anesthesia and nonobstetric surgery during pregnancy were reported to be related to a higher incidence of prematurity and intrauterine growth retardation [19] and abortion [20, 21]. However, recent clinical data suggested that general anesthesia in pregnant patients may not have as much potential for harm as previously thought [22, 23].…”

Section: Discussionmentioning

confidence: 99%

Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy

Cui

Sun

et al. 2017

International Journal of Endocrinology

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Background Primary hyperparathyroidism (pHPT) in pregnancy is a rare event, but it poses a significant risk to mothers and fetuses. The optimal treatment strategy remains controversial. Methods We present a consecutive series of twelve pregnant women with pHPT. Results Twelve women were diagnosed with pHPT during pregnancy or in the postpartum period. Four of them presented no symptoms or mild symptoms. Four patients experienced serious complications, including hypercalcaemic crisis, acute pancreatitis, and eclampsia. Another four patients were identified postpartum as the result of neonatal convulsion with hypocalcaemia. Minimally invasive parathyroidectomy (MIP) under cervical plexus block was successfully performed in 11 of them during pregnancy or postpartum. The serum levels of ionized calcium and intact parathyroid hormone (iPTH) were much higher in patients with severe complications in this cohort than those in the group of patients with no symptoms or mild symptoms and patients who were diagnosed postpartum. Conclusions MIP under cervical plexus block might be a safe and effective treatment for pregnant women with pHPT. Even though both conservative and surgical treatments are applicable for most mothers and fetuses with asymptomatic and mild hyperparathyroidism, serious complications may have catastrophic consequences for both.

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“…The risk of teratogenesis for the fetus in normal pregnancy is approximately 1 to 3% [20]. The risk is highest in the first trimester, and observational studies have investigated the risk of fetal teratogenicity in first trimester exposure of pregnant women to surgery and anesthesia [21,22]. No increased risk of fetal teratogenesis was observed, but the exposure to sedatives and analgesics was limited to a short period in the operating room.…”

Section: Potential Effects Of Icu Management On the Fetusmentioning

confidence: 99%

Fetal outcome in the critically ill pregnant woman

2014

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Management of the critically ill pregnant woman is complicated by potential adverse effects of both maternal illness and ICU interventions on the fetus. This paper reviews the potential risks to the fetus of maternal critical illness, including shock, hypoxemia, and fever, as well as the effects of critical care management, such as drug therapy and radiological investigations. The authors’ recommended approach to management is provided. Prior publications and new data presented identify that there is insufficient information to prognosticate accurately on fetal outcome after maternal critical illness, although maternal shock, hypoxemia and early gestational age are likely significant risk factors.

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Fetal Risk of Anesthesia and Surgery during Pregnancy

Cited by 297 publications

References 0 publications

Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Estimating the risk of adverse birth outcomes in pregnant women undergoing non-obstetric surgery using routinely collected NHS data: an observational study

Clinical Presentation, Management, and Outcomes of Primary Hyperparathyroidism during Pregnancy

Fetal outcome in the critically ill pregnant woman

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