J Korean Med Sci.  2020 Apr;35(16):e113. 10.3346/jkms.2020.35.e113.

Factors Affecting Maternal and Fetal Outcomes of Non-Obstetric Surgery and Anesthesia during Pregnancy: a Retrospective Review of Data at a Single Tertiary University Hospital

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea

Abstract

Background
Anesthesia during pregnancy for non-obstetric surgery is generally known to have a negative impact on maternal and fetal outcomes. We assessed the risk of adverse outcomes in fetuses and mothers associated with non-obstetric surgery.
Methods
This retrospective study analyzed clinical data on pregnant women who received non-obstetric surgeries at a tertiary university hospital. We reviewed maternity admissions using hospital administrative data during the last 16 years. The outcome assessment included the presence of preterm labor, premature birth, abortion, or stillbirth and the data of newborns. Statistical analyses were performed using the t-test, χ2 test, and multiple logistic regression was used for risk analysis.
Results
The incidence of non-obstetric surgery during pregnancy was 0.96%. Gestational age at or above 20 weeks increased the risk of all adverse events 4.5 fold when it was compared to gestational age less than 20 weeks, although the events were only preterm labor or premature birth and no fetal loss. All fetal loss cases occurred in patients at less than 20 weeks of pregnancy. The risk of adverse outcome increased by 2% for every 1 minute increase in anesthesia time. Babies of the mothers who had the adverse outcome event showed lower birth weight and higher neonatal intensive care unit admission rate than those of babies of the mothers without any adverse event after the surgery.
Conclusion
Physicians should acknowledge and prepare for common possible adverse events at the stage of pregnancy after non-obstetric surgery, and effort to shorten the duration of surgery and anesthesia is needed.

Keyword

Pregnancy; Premature Birth; Preterm Labor; Anesthesia; Surgery

Figure

  • Fig. 1 Flow chart of patients' enrollment.


Reference

1. Balinskaite V, Bottle A, Sodhi V, Rivers A, Bennett PR, Brett SJ, et al. The risk of adverse pregnancy outcomes following nonobstetric surgery during pregnancy: estimates from a retrospective cohort study of 6.5 million pregnancies. Ann Surg. 2017; 266(2):260–266. PMID: 27617856.
2. Ní Mhuireachtaigh R, O'Gorman DA. Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth. 2006; 18(1):60–66. PMID: 16517336.
Article
3. Lee GY. Retrospective evaluation of anesthetic management for pregnant surgical patients. Korean J Anesthesiol. 2004; 46(4):414–418.
Article
4. Yoon JR, Chung EY, Kim YS, Kim YH, Yeon JS, Kim TK. Retrospective anesthetic evaluation of non-obstetric surgery during pregnancy: single center experience. Anesth Pain Med. 2018; 13(2):165–172.
Article
5. Duncan PG, Pope WD, Cohen MM, Greer N. Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology. 1986; 64(6):790–794. PMID: 3717642.
Article
6. 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(3):673–679. PMID: 9322641.
Article
7. Cohen-Kerem R, Railton C, Oren D, Lishner M, Koren G. Pregnancy outcome following non-obstetric surgical intervention. Am J Surg. 2005; 190(3):467–473. PMID: 16105538.
Article
8. Hong JY. Adnexal mass surgery and anesthesia during pregnancy: a 10-year retrospective review. Int J Obstet Anesth. 2006; 15(3):212–216. PMID: 16798446.
Article
9. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg. 2012; 99(11):1470–1478. PMID: 23001791.
Article
10. Ibiebele I, Schnitzler M, Nippita T, Ford JB. Appendicectomy during pregnancy and the risk of preterm birth: a population data linkage study. Aust N Z J Obstet Gynaecol. 2019; 59(1):45–53. PMID: 29602171.
Article
11. Devroe S, Bleeser T, Van de Velde M, Verbrugge L, De Buck F, Deprest J, et al. Anesthesia for non-obstetric surgery during pregnancy in a tertiary referral center: a 16-year retrospective, matched case-control, cohort study. Int J Obstet Anesth. 2019; 39:74–81. PMID: 30772120.
Article
12. Committee on Obstetric Practice and the American Society of Anesthesiologists. Committee opinion No. 696: nonobstetric surgery during pregnancy. Obstet Gynecol. 2017; 129(4):777–778. PMID: 28333816.
13. Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol. 1989; 161(5):1178–1185. PMID: 2589435.
Article
14. Heesen M, Klimek M. Nonobstetric anesthesia during pregnancy. Curr Opin Anaesthesiol. 2016; 29(3):297–303. PMID: 26859466.
Article
15. Bonnet MP. Sedation and anaesthesia for non-obstetric surgery. Anaesth Crit Care Pain Med. 2016; 35 Suppl 1:S35–S41. PMID: 27381821.
Article
16. Eom JM, Hong JH, Jeon SW, Choi JS, Lee JH, Kim HO, et al. Safety and clinical efficacy of laparoscopic appendectomy for pregnant women with acute appendicitis. Ann Acad Med Singapore. 2012; 41(2):82–86. PMID: 22498855.
17. Min JW, Kang YD. A comparison of laparoscopic versus open appendectomy during pregnancy. Korean J Obstet Gynecol. 2011; 54(5):236–240.
Article
18. Walton N, Melachuri VK. Anaesthesia for non-obstetric surgery during pregnancy. Contin Educ Anaesth Crit Care Pain. 2006; 6(2):83–85.
Article
19. Nezhat FR, Tazuke S, Nezhat CH, Seidman DS, Phillips DR, Nezhat CR. Laparoscopy during pregnancy: a literature review. JSLS. 1997; 1(1):17–27. PMID: 9876642.
20. Walsh CA, Tang T, Walsh SR. Laparoscopic versus open appendicectomy in pregnancy: a systematic review. Int J Surg. 2008; 6(4):339–344. PMID: 18342590.
Article
21. Weston P, Moroz P. Appendicitis in pregnancy: how to manage and whether to deliver. Obstet Gynecol. 2015; 17(2):105–110.
Article
22. Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC. Non-obstetric surgery during gestation: risk factors for lower birthweight. Aust N Z J Obstet Gynaecol. 2003; 43(1):27–31. PMID: 12755343.
Article
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr