Results
From a total of 3,276,776 of women who gave birth during 2007-2015, 8,167 (0.25%) underwent non-obstetric abdominal surgery, including 5,109 laparotomy patients and 3,108 laparoscopy patients. Table 1 shows the pregnancy characteristics of patients with or without surgery during pregnancy.
Table 1 shows the general and pregnancy characteristics of patients between pregnancies with and without surgery. For pregnancies in the surgery group, maternal age < 35 years, nulliparity, preterm birth, LBW, gestational hypertension, GDM, C/S, placenta previa, and placenta abruption were more common than in pregnancies in the group that did not undergo surgery. Table 2 shows the general and pregnancy characteristics of the laparoscopy and laparotomy groups. When comparing laparoscopy and laparotomy, in the laparoscopy group, maternal age < 35 years, nulliparity, C/S, gestational hypertension, GDM, and placenta previa were more common than in the laparotomy group. Preterm delivery, low birth weight, and placenta abruption were less common in the laparoscopic group compared with the laparotomy group.
Figure 2 shows the results of Cox proportional hazards regression analyses with fetal and obstetric complications after controlling for age and parity. There was a statistically significant increase in risk of preterm birth (HR 2.06, 95% CI 1.86-2.29), LBW (HR 1.65, 95% CI 1.49-1.82), C/S (HR 1.14, 95% CI 1.09-1.19), gestational hypertension (HR 1.36, 95% CI 1.19-1.56), and placenta previa (HR 1.57, 95% CI 1.33-1.87) in both the laparotomy and laparoscopy groups. The risk of placental abruption was significantly increased only in the laparotomy group (HR 1.59, 95% CI 1.12-2.27).
When comparing the laparoscopic and laparotomy groups for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (HR 0.62, 95% CI 0.40-0.95) (Table 3). Otherwise, there were no statistically significant differences between the two groups. In addition, in the laparoscopic group, the hospital stay was statistically significantly shorter than for the laparotomy group (6.13±2.76 vs. 5.62±2.75 days, P<0.001).