“Clearly, surgery during pregnancy should only be considered if
absolutely necessary,” said Paul Aylin, study co-author and an
epidemiologist at the Imperial College London in England.
But when expectant mothers do need to undergo surgery, “the
information provided in our analysis may give reassurance,” he told
Reuters Health by email.
Aylin and colleagues used England’s national hospital database to
identify nearly 6.5 million pregnancies between 2002 and 2012,
including 47,628 in which the moms had nonobstetric surgery.
The most common operations involved the abdomen, dental issues, the
nails and skin, orthopedic conditions, the ear, nose or throat, the
perianal region, and the breast.
Overall, surgery during pregnancy was associated with a higher risk
of birth complications, but the amount of that increased risk that
could be blamed on the surgery was relatively small, according to
They found that for every 143 surgeries, there was one extra case of
a hospital miscarriage. In addition, there was one extra stillbirth
among every 287 women who had surgery, one preterm delivery among
every 31 surgery patients, one underweight baby for every 39 women
in the surgery group, and one maternal death for every 7,962
Approximately two-thirds of all abdominal operations were
laparoscopic – but laparoscopic abdominal surgery was linked with a
nearly four times higher risk of miscarriage compared with open
abdominal surgery, the authors found.
Fewer than 6 percent of the operations occurred within one week of
the end of pregnancy, however.
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Overall, after accounting for other factors that might increase
expectant mothers’ risks for these bad outcomes, nonobstetric
surgery was found to increase the risk by 0.7 percent for
miscarriage, 0.4 percent for still birth, 3.2 percent for preterm
delivery, 2.6 percent for low birth weight, 4 percent for cesarean
section, and 0.013 percent for maternal death, the authors reported
in Annals of Surgery.
“This study puts it into perspective that other risk factors are at
play and this is the amount of risk that can be blamed on the
surgery,” said Dr. Daniela Carusi, an obstetrician gynecologist and
director of Surgical Obstetrics at Brigham and Women’s Hospital in
“The risk you can attribute to surgery may be small, but it’s not
zero,” said Carusi, who was not involved with the study. “Because of
that, it’s important to consider the safest alternative.”
In some cases, it might be better to wait. “But if it’s a medical
condition, like appendicitis, then surgery may be the better
option,” she said.
SOURCE: http://bit.ly/2dlhyr0 Annals of Surgery, online September
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