Introduction
One to two percent of women undergo non-obstetric surgery during pregnancy, including appendectomy, gynecologic surgery, and cancer surgery.1 Non-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. In a Canadian study of 2,565 pregnant women, there was increased risk of spontaneous abortion after general anesthesia.2 A Swedish registry study showed increased risk of preterm birth and growth restriction in the surgery group.3 In a 6.5 million patient cohort in the UK, non-obstetric surgery during pregnancy was associated with adverse birth outcomes such as stillbirth, preterm delivery, low birth weight, and cesarean section.4 The American College of Obstetricians and Gynecologists (ACOG) committee noted that, although no teratogenic effect of anesthetics during pregnancy has been proven, obstetric and fetal complications may increase.
Laparoscopic surgery during pregnancy has become widely used, although there has been concern for uterine injury from trocar placement and fetal malperfusion due to pneumoperitoneum during laparoscopic surgery over the past two decades.5 Several systematic reviews and meta-analyses have suggested that laparoscopic surgery may be similar or preferable to laparotomy during pregnancy.6-11 The majority of previous studies, however, has included a small number of patients and targeted only certain operations, such as appendectomy or ovarian surgery. Recently, a Japanese registry study confirmed the advantages of laparoscopic surgery for benign diseases compared with laparotomy in 6,018 pregnant women who underwent surgery. However, that study was limited because it did not evaluate risk of major obstetric/fetal complications, including gestational hypertension, cesarean section, and low birth weight, but only assessed abortion, stillbirth within 7 days after surgery, and premature birth during hospitalization.12
The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric abdominal surgery during pregnancy compared with those who did not undergo such surgery. The study also compared maternal and fetal outcomes after laparoscopy versus laparotomy for benign disease during pregnancy.