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.