Non‐obstetric abdominal surgery during pregnancy and birth outcomes: A Danish registry‐based cohort study

Abstract

Introduction Surgery during pregnancy may increase the risk of adverse birth outcomes. In this nationwide registry‐based cohort study including women aged 15‐54 years with singleton birth or miscarriage, we examined the association between non‐obstetric abdominal surgery during pregnancy and the birth outcomes small‐for‐gestational‐age (SGA), preterm birth, and miscarriage. Material and methods The study used data on births or miscarriages from the large national Danish registries in 1997‐2015. We calculated absolute risks and risk differences for the main outcomes and used Cox regression analysis with non‐obstetric abdominal surgery as a time‐varying exposure, adjusting for maternal age, year of last menstrual period, major abdominal surgery before pregnancy, maternal smoking status, rheumatoid arthritis, diabetes and inflammatory bowel disease. Our main outcome measures were risks and hazard ratios (HRs) for SGA, very preterm or preterm birth, and miscarriage after gestational week 7 overall, stratified by calendar year, and, for SGA, trimester of pregnancy. Finally, absolute risk of miscarriage stratified by time since surgery. Results Absolute risks in surgically treated vs untreated were 3.4% vs 2.7% for SGA (adjusted HR 1.3, 95% CI 1.1‐1.5), 2.2% vs 0.8% for very preterm birth (adjusted HR 2.8, 95% CI 2.2‐3.5), 8.3% vs 4.3% for preterm birth (adjusted HR 2.1, 95% CI 1.9‐2.3), and 8.2% vs 6.1% for miscarriage (adjusted HR 3.1, 95% CI 2.7‐3.5). For miscarriage, the risk was highest the first week after surgery and levelled out after 2 weeks. Conclusions Surgery during pregnancy is associated with an increased risk of SGA, very preterm birth, preterm birth and miscarriage, and the risk of miscarriage is highest the first week after surgery.

Surgery due to Inflammatory Bowel Disease During Pregnancy: Mothers and Offspring Outcomes From an ECCO Confer Multicentre Case Series [Scar Study]

“…However, the decisions regarding timing, approach and the appropriateness of surgery are often challenging. There have been few published reports on IBD surgery during pregnancy most likely due to low frequency and underreporting [7][8][9][10][11] . In this respect, data on the outcomes of surgery due to IBD in pregnant patients are scarce, and primarily date back more than 3 decades ago predating the use of biologic therapy, minimally invasive surgery and current perioperative management and support 7 .…”

“…In general, it has been reported that both sigmoidoscopy and colonoscopy are of low risk in pregnant IBD patients and can guide the decision making process in a high proportion of patients [19][20][21] . Some authors have suggested that surgery is of lowest risk when undertaken during the 2 nd trimester there are higher risks of miscarriage in the 1 st trimester and increased risks of maternal/foetal morbidity and mortality during the 3 rd trimester 7,11 . Nevertheless, and despite With respect to the surgical approach, a minimally invasive approach is advocated by a number of authors from extrapolation from general surgical procedures during pregnancy or from surgery in non-pregnant IBD patients 7,[22][23][24] .…”

“…Two of the 4 miscarriages/stillbirths in our cohort occurred during surgery and the other two, 2 weeks after surgery. Rasmussen et al examined the association between nonobstetric abdominal surgery during pregnancy and the birth outcomes using data from the national Danish registries covering 1997-2015 11 . The absolute risk of miscarriage was stratified by time since surgery.…”

Management of Pregnant Women Hospitalized with a Flare of Inflammatory Bowel Disease

“…Women with obstruction, abscess, refractory colitis, hemorrhage, and appendicitis, among other medical conditions, may require more emergent surgery during pregnancy. A study using the Danish national registries of 1,202,870 pregnancies, including 4490 (0.4%) women who had non-obstetric abdominal surgery during pregnancy, showed increased risk of small for gestational age, very preterm births, preterm birth, and miscarriage among women who underwent surgery during pregnancy; the greatest risk for these outcomes occurred within 14 days after surgery [53]. The risk of miscarriage decreased with time after surgery and, after 2 weeks, approached that of pregnancies without surgery.…”

Ectopic decidua of the appendix: a case report

“…Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy, followed by cholecystitis, pancreatitis, and bowel obstruction [ 3 , 4 ]. In addition, acute appendicitis is the most common cause of non-obstetric surgical intervention performed during pregnancy, accounting for 25% of non-obstetric surgical interventions during pregnancy [ 5 , 6 ].…”