Anesth Pain Med.  2018 Apr;13(2):165-172. 10.17085/apm.2018.13.2.165.

Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience

• Yoon JR
• Chung EY
• Kim YS
• Kim YH
• Yeon JS
• Kim TK

• KMID: 2437423
• DOI: http://doi.org/10.17085/apm.2018.13.2.165

Abstract

BACKGROUND
Laparoscopic procedures and ultrasonography are now commonly used in the obstetric field, and more non-obstetric procedures are being performed. However, little domestic data has been published on the topic. This present retrospective study investigated the clinical information and the effect on perinatal outcomes of non-obstetric surgery during pregnancy.
METHODS
This retrospective study was performed using data of all adult pregnant women that underwent non-obstetric surgery at our institute between from July 2009 to December 2016. Data was collected from the institutional computerized database. The causes, types, and the gestational ages at surgery were collected as our primary outcomes. Basic characteristics of patients, operation times, anesthesia times, anesthetic methods, anesthetic agents, and adverse perinatal outcomes such as abortion or preterm delivery were evaluated as secondary outcomes.
RESULTS
During the study period, there were 2,421 deliveries and 60 cases of non-obstetric surgery, an operation rate of 2.48%. The most common cause of non-obstetric surgery was abdominal surgery, followed by orthopedic surgery and neurosurgery. Most of abdominal surgeries were performed laparoscopically during the first trimester. The incidence of adverse perinatal outcomes was increased in the first trimester, was not related with anesthesia.
CONCLUSIONS
The rate of non-obstetric surgery was found to be 2.48%, which was higher than those reported in previous domestic studies. This increase seems to have resulted from early diagnosis by ultrasonography and non-invasive surgery using laparoscopy. Adverse perinatal outcomes are not related with age, surgery and anesthetic-related factors but seem to be associated with surgery exposure stage, especially the first trimester.

Keyword

Obstetric anesthesia; Patient outcome assessment; Pregnancy

MeSH Terms

Adult
Anesthesia
Anesthesia, Obstetrical
Anesthetics
Early Diagnosis
Female
Gestational Age
Humans
Incidence
Laparoscopy
Neurosurgery
Orthopedics
Patient Outcome Assessment
Pregnancy Trimester, First
Pregnancy*
Pregnant Women
Retrospective Studies*
Ultrasonography
Anesthetics

Figure

• 

  Fig. 1 Flow diagram of patient selection processes for this study. C /section: cesarean section. *A total 14 case of operation performed under local anesthesia were as follows: loop electrosurgical excision procedures, cheek epidermal inclusion cysts, vaginal repairs, cervix polypectomy, breast local excisions, dog bite wound.

Reference

1. Goodman S. Anesthesia for nonobstetric surgery in the pregnant patient. Semin Perinatol. 2002; 26:136–45. DOI: 10.1053/sper.2002.32203. PMID: 12005471.

2. Kuczkowski KM. The safety of anaesthetics in pregnant women. Expert Opin Drug Saf. 2006; 5:251–64. DOI: 10.1517/14740338.5.2.251. PMID: 16503746.

3. Kuczkowski KM. Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv. 2004; 59:52–6. DOI: 10.1097/01.OGX.0000103191.73078.5F. PMID: 14707749.

4. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br J Anaesth. 2011; 107(Suppl 1):i72–8. DOI: 10.1093/bja/aer343. PMID: 22156272.

5. Flood P, Rollins MD. Anesthesia for obstetrics. Miller's Anesthesia. 8th ed. Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Philadelphia: Churchill Livingstone/Elsevier;2015. p. 2328–58.

6. Cheek TG, Baird E. Anesthesia for nonobstetric surgery: maternal and fetal considerations. Clin Obstet Gynecol. 2009; 52:535–45. DOI: 10.1097/GRF.0b013e3181c11f60. PMID: 20393407.

7. Shay DC, Bhavani-Shankar K, Datta S. Laparoscopic surgery during pregnancy. Anesthesiol Clin North America. 2001; 19:57–67. DOI: 10.1016/S0889-8537(05)70211-X.

8. Goh W, Bohrer J, Zalud I. Management of the adnexal mass in pregnancy. Curr Opin Obstet Gynecol. 2014; 26:49–53. DOI: 10.1097/GCO.0000000000000048. PMID: 24614018.

9. Rosen MA. Management of anesthesia for the pregnant surgical patient. Anesthesiology. 1999; 91:1159–63. DOI: 10.1097/00000542-199910000-00033. PMID: 10519516.

10. Bajwa SJ, Bajwa SK. Anaesthetic challenges and management during pregnancy: Strategies revisited. Anesth Essays Res. 2013; 7:160–7. DOI: 10.4103/0259-1162.118945. PMID: 25885826. PMCID: PMC4173524.

11. Lee CH. Clinical observations concerning non-obstetric surgery in the pregnant patient. Korean J Anesthesiol. 1984; 17:347–52. DOI: 10.4097/kjae.1984.17.4.347.

12. Lee GY. Retrospective evaluation of anesthetic management for pregnant surgical patients. Korean J Anesthesiol. 2004; 46:414–8. DOI: 10.4097/kjae.2004.46.4.414.

13. Gurbuz AT, Peetz ME. The acute abdomen in the pregnant patient. Is there a role for laparoscopy? Surg Endosc. 1997; 11:98–102. DOI: 10.1007/s004649900306. PMID: 9069135.

14. Friedman JD, Ramsey PS, Ramin KD, Berry C. Pneumoamnion and pregnancy loss after second-trimester laparoscopic surgery. Obstet Gynecol. 2002; 99:512–3. DOI: 10.1016/S0029-7844(01)01664-7. DOI: 10.1097/00006250-200203000-00025. PMID: 11864684.

15. Al-Fozan H, Tulandi T. Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol. 2002; 14:375–9. DOI: 10.1097/00001703-200208000-00003. PMID: 12151826.

16. Reedy MB, Källén B, Kuehl TJ. Laparoscopy during pregnancy: a study of five fetal outcome parameters with use of the Swedish Health Registry. Am J Obstet Gynecol. 1997; 177:673–9. DOI: 10.1016/S0002-9378(97)70163-7.

17. Heesen M, Klimek M. Nonobstetric anesthesia during pregnancy. Curr Opin Anaesthesiol. 2016; 29:297–303. DOI: 10.1097/ACO.0000000000000311. PMID: 26859466.

18. Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989; 161:1178–85. DOI: 10.1016/0002-9378(89)90659-5.

19. Minig L, Otaño L, Cruz P, Patrono MG, Botazzi C, Zapardiel I. Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. J Minim Access Surg. 2016; 12:22–5. DOI: 10.4103/0972-9941.171960. PMID: 26917915. PMCID: PMC4746970.

20. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005; 190:467–73. DOI: 10.1016/j.amjsurg.2005.03.033. PMID: 16105538.