Nonobstetric surgery during pregnancy: risk factors for mother and child

Non-obstetric surgery is combined with maternal and fetal risks during pregnancy. Aim of the study is to review own patients and discuss the literature related to this topic.

Cases:

1) Acute abdominal pain required surgery in a pregnant woman at 16 gestational weeks. During surgery, peritonitis was present of unknown cause. Three days later intrauterine death was diagnosed. After spontaneous delivery the patient became increasingly ill, relaparotomy showed a rectal defect and faeces intra-abdominal. Retrospective it was assumed that the primary source of infection was pelvic: explained by the pathologic findings of a superficial infection of the appendix removed at primary surgery and a purulent infection of the placenta causing intra-uterine death.

2) Suspected appendicitis lead to appendectomy at 13 gestational weeks. Histologic examination revealed appendix sana. Recovery is complicated by wound infection, treated with drainage. At 17 weeks of gestation the patient delivered immaturely. Post mortem pathology shows an acute pneumonia and chorionamnionitis.

3) Operation of a benign adnexal tumor was performed at 14 gestational weeks. The patient delivered a healthy baby at term.

Discussion: These cases show that non-obstetric surgery during pregnancy isnrsquor;t always without hazard. Adverse outcome parameters are an increased risk for neonatal mortality, preterm labour and low-birth-weight infants, especially if appendicitis or peritonitis are present. Neonatal mortality can rise up to 10% and the risk for preterm labour is the highest during the first week after surgery. Decisions about surgery should be made in a multidisciplinary team and elective surgery should be avoided.