Asya ÖZCAN, Semra YÜKSEL, Zeynep GEDİK ÖZKÖSE, İsmail ÖZDEMİR

GEBELİK SIRASINDA GEÇİRİLEN NON-OBSTETRİK CERRAHİ SONRASI MATERNAL VE FETAL SONUÇLAR

Amaç: Gebelik sırasında yapılan non-obstetrik cerrahilerde gebeliğin devamı ve neonatal sürecin nasıl etkileyeceği hem gebe hem cerrah tarafından önem arz etmektedir. Non-obstetrik cerrahiler ile ilgili çalışmalar sınırlı sayıdadır. Bu çalışmamızın amacı non-obstetrik cerrahi sonrası maternal ve fetal sonuçların değerlendirilmesidir. Yöntem: Çalışmamız tersiyer bir merkez olan hastanemizin obstetri kliniğimizde Ocak 2015-Ağustos 2020 tarihleri arasındaki non-obstetrik cerrahi yapılan 60 gebe hastanın retrospektif değerlendirilmesini içermektedir. Hasta bilgilerine elektronik sistem ve arşiv dosyalarından ulaşıldı. Hastaların demografik özellikleri, cerrahi yapılan hafta, takipleri, gebelik ve neonatal sonuçları değerlendirildi. Bulgular: Hastaların ortalama yaşı 27,9±4,42 cerrahi yapılan gebelik haftası ortalama 17,7±11,3 idi. Cerrahi endikasyonlar arasında en sık neden 45 hasta ile (%75) apandisittir. Gebelerin %88,3’üne acil cerrahi yapıldı. Ortalama hastanede kalış süresi 3,3±3,2 gün, doğuma kadar geçen ortalama hafta 21,1±8,6 idi. Gebelerin ortalama doğum haftası 37,8±2,8 idi. Acil cerrahi yapılan hastalarda laparotomi tercihi laparoskopiye göre anlamlı olarak yüksek bulundu (P=0.007). Laparotomi(LT) ve laparoskopi(LSK) grubunda gebelik sonuçları ve neonatal sonuçlar açısından fark saptanmadı. Sonuç: Gebelikte geçirilen non-obstetrik cerrahi olumsuz gebelik ve neonatal sonuçlarda artışa yol açtığına dair bir sonuca ulaşılamamıştır. Ayrıca cerrahi şeklini değerlendirdiğimizde; laparotomi ve laparoskopi yapılan gruplar arasında gebelik ve neonatal sonuçlar açısından anlamlı bir fark bulunmadı. Bu konuda daha geniş çaplı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

gebelikte cerrahi, non-obstetrik cerrahi, gebelikte laparoskopi

MATERNAL AND FETAL RESULTS AFTER NON-OBSTETRIC SURGERY DURING PREGNANCY

Objectives: In non-obstetric surgeries performed during pregnancy, the continuation of pregnancy and how it will affect the neonatal process are important for both the pregnant and the surgeon. Studies on non-obstetric surgeries are limited. The aim of this study is to evaluate maternal and fetal outcomes after non-obstetric surgery. Methods: Our study includes the retrospective evaluation of 60 pregnant patients who underwent non-obstetric surgery between January 2015 and August 2020 in our obstetrics clinic, which is a tertiary center. Patient information was obtained from electronic system and archive files. Demographic characteristics of the patients, week of surgery, follow-up, pregnancy and neonatal outcomes were evaluated. Results: The mean age of the patients was 27.9±4.42, and the mean gestational week at which surgery was performed was 17.7±11.3. Among the surgical indications, the most common cause is appendicitis with 45 patients (75%). Emergency surgery was performed in 88.3% of the pregnant women. The mean hospital stay was 3.3±3.2 days, and the mean week to delivery was 21.1±8.6. The mean delivery week of the pregnant women was 37.8±2.8. Laparotomy preference was found to be significantly higher than laparoscopy in patients who underwent emergency surgery (P=0.007). There was no difference in pregnancy outcomes and neonatal outcomes in the laparotomy (LT) and laparoscopy (LSK) groups. Conclusions: There was no conclusion that non-obstetric surgery during pregnancy led to an increase in adverse pregnancy and neonatal outcomes. In addition, when we evaluate the type of surgery; There was no significant difference between the laparotomy and laparoscopy groups in terms of pregnancy and neonatal outcomes. More extensive studies are needed on this subject.

Keywords:

surgery in pregnancy, non-obstetric surgery, laparoscopy in pregnancy,

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1. Kwon H, Lee M, Park HS, et al. Laparoscopic management is feasible for nonobstetric surgical disease in all trimesters of pregnancy. Surg Endosc. 2018;32(6):2643-2649. doi:10.1007/s00464-018-6189-x
2.Balinskaite V, Bottle A, Sodhi V, 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. doi:10.1097/SLA.0000000000001976
3. Miloudi N, Brahem M, Ben Abid S, et al. Acute appendicitis in pregnancy: specific features of diagnosis and treatment. J Visc Surg. 2012;149(4):e275-e279. doi:10.1016/j.jviscsurg.2012.06.003
4. Tumati A, Yang J, Zhang X, et al. Pregnant patients requiring appendectomy: comparison between open and laparoscopic approaches in NY State. Surg Endosc. 2021;35(8):4681-4690. doi:10.1007/s00464-020-07911-y
5. Saccardi C, Visentin S, Noventa M, et al. Uncertainties about laparoscopic myomectomy during pregnancy: A lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case. Minim Invasive Ther Allied Technol. 2015;24(4):189-194. doi:10.3109/13645706.2014.987678
6. Richards PA, Richards PD, Tiltman AJ. The ultrastructure of fibromyomatous myometrium and its relationship to infertility. Hum Reprod Update. 1998;4(5):520-525. doi:10.1093/humupd/4.5.520
7. Algara AC, Rodríguez AG, Vázquez AC, et al. Laparoscopic Approach for Fibroid Removal at 18 Weeks of Pregnancy. Surg Technol Int. 2015;27:195-197.
8. Yoshino O, Hayashi T, Osuga Y, et al. Decreased pregnancy rate is linked to abnormal uterine peristalsis caused by intramural fibroids. Hum Reprod. 2010;25(10):2475-2479. doi:10.1093/humrep/deq222
9. Chen YF, Hsu ST, Ho ES, et al. Tuboovarian abscess in pregnancy. Taiwan J Obstet Gynecol. 2008;47(3):370-371. doi:10.1016/S1028-4559(08)60148-5
10. Piegzová A, Unzeitig V. Tuboovariální absces ve 39. týdnu gravidity (kazuistika) [Tubo-ovarian abscess in the 39th week of pregnancy (case report)]. Ceska Gynekol. 2017;82(4):322-326.
11. Nasioudis D, Tsilimigras D, Economopoulos KP. Laparoscopic cholecystectomy during pregnancy: A systematic review of 590 patients. Int J Surg. 2016;27:165-175. doi:10.1016/j.ijsu.2016.01.070
12. Ko CW, Napolitano PG, Lee SP, et al. Physical activity, maternal metabolic measures, and the incidence of gallbladder sludge or stones during pregnancy: a randomized trial. Am J Perinatol. 2014;31(1):39-48. doi:10.1055/s-0033-1334455
13. Shui LH, Rafi J, Corder A, et al. Mid-gut volvulus and mesenteric vessel thrombosis in pregnancy: case report and literature review. Arch Gynecol Obstet. 2011;283 Suppl 1:39-43. doi:10.1007/s00404-010-1789-2
14. Prodromidou A, Machairas N, Kostakis ID, et al. Outcomes after open and laparoscopic appendectomy during pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;225:40-50. doi:10.1016/j.ejogrb.2018.04.010
15. Vujic J, Marsoner K, Lipp-Pump AH, et al. Non-obstetric surgery during pregnancy - an eleven-year retrospective analysis. BMC Pregnancy Childbirth. 2019;19(1):382. Published 2019 Oct 25. doi:10.1186/s12884-019-2554-6
16. Aggenbach L, Zeeman GG, Cantineau AE, et al. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg. 2015;15:84-89. doi:10.1016/j.ijsu.2015.01.025
17. Koo YJ, Kim HJ, Lim KT, et al. Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy. Aust N Z J Obstet Gynaecol. 2012;52(1):34-38. doi:10.1111/j.1479-828X.2011.01380.x
18. Date RS, Kaushal M, Ramesh A. A review of the management of gallstone disease and its complications in pregnancy. Am J Surg. 2008;196(4):599-608. doi:10.1016/j.amjsurg.2008.01.015
19. Pearl J, Price R, Richardson W, et al; Society of American Gastrointestinal Endoscopic Surgeons. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2011;25(11):3479-3492. doi:10.1007/s00464-011-1927-3
20. Pearl JP, Price RR, Tonkin AE, et al. SAGES guidelines for the use of laparoscopy during pregnancy. Surg Endosc. 2017;31(10):3767-3782. doi:10.1007/s00464-017-5637-3
21. Fong ZV, Pitt HA, Strasberg SM, et al. Cholecystectomy During the Third Trimester of Pregnancy: Proceed or Delay?. J Am Coll Surg. 2019;228(4):494-502.e1. doi:10.1016/j.jamcollsurg.2018.12.024