Pregnancy Outcomes Following Laparoscopic and Open Surgery in Pelvis during Pregnancy: a Nationwide Population-based Study in Korea

Abstract

Background Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery. Methods Study data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models. Results Data from 4,439,778 women were collected for this study. From 2006–2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81–2.23), LBW (HR, 1.62; 95% CI, 1.46–1.79), C/S (HR, 1.13; 95% CI, 1.08–1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18–1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40–0.95). Conclusion Non-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review

“…Fourteen studies reported population-based data, 10–12,15,22,23,26,29,31,33,35,42,45,50 three studies reported multicenter data 36,39,60 and 43 studies reported single-center data, 13,14,16–21,24,25,27,28,30,32,34,37,38,40,41,43,44,46–49,51–59,61–69 and all, expect one small prospective single-center study on 22 women,63 were retrospective.…”

“…In four studies comparing that aspect, the prevalence was 6.6% (n = 6661) in pregnancies in which non-obstetric surgery was performed and 6.0% (n = 2,328,110) in pregnancies with no surgery, OR 1.1 [1.0-1.2], respectively. 23,26,33,50 In Cho et al 15 study, the prevalence of low birth weight was 5,6% after laparoscopic and 5,8% after open surgery. The prevalence of small for gestational age was 7.0% after laparoscopic surgery (n = 640) and 9.2% after open surgery (n = 521), with an OR of 0.7 [0.5-1.1].…”

“…11,15,21,59,67 There were data for 4,452,453 pregnant women with 4,281 non-obstetric gynecologic surgery (prevalence 0.08%). In a study by Cho et al, 15 laparoscopy was used in 44% of cases. In a study by Haataja et al, 11 32% of surgeries were performed in the first, 40% trimester, 40% in the second, and 28% in the third trimester ( p < 0.001).…”

“…Preterm birth (birth before 37 weeks of pregnancy) was the most commonly reported outcome, reported in 54 studies. 10-17, 19-39, 41-46, 48, 50-54, 56-63, 65-69 There were 8265 (9.7%) preterm births in 67,367 pregnancies in women with non-obstetric surgery. Fourteen studies compared data on preterm births in women with non-obstetric surgery ( n = 73,110) and with no surgery during pregnancy ( n = 14,833,865).…”

A Self-Made Bag-Assisted Laparoendoscopic Single-Site Surgery in Ovarian Teratomectomy during Pregnancy

“…The reported incidence of ovarian cysts in pregnancy varies from 0.05% to 1.2%; compared with open surgery, laparoscopic surgery adnexal cyst during pregnancy does not increase the risk to mother and fetus. [ 1 2 ] In addition, LESS has better postoperative recovery. However, conventional laparoscopic surgery is safer than LESS.…”