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

Yıl 2023, , 97 - 105, 30.08.2023

Asya Özcan , Semra Yüksel , Zeynep Gedik Özköse , İsmail Özdemir

https://doi.org/10.34084/bshr.1278592

Öz

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 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