Pregnancy outcomes following pelvic surgery during pregnancy: a
nationwide population-based study in Korea
Abstract
Objective To investigate the risk of adverse birth outcomes for women
who underwent non-obstetric abdominal surgery during pregnancy compared
with that of those who did not undergo surgery. Design Retrospective
cohort study Setting Korea National Health Insurance (KNHI) claims
database Population A total of 8,167 women who did non-obstetric surgery
and 3,710,123 women who did not undergo surgery and in 2006-2016.
Methods The two groups were compared using a multivariate Cox
proportional hazard model. The primary outcome assessed was neonatal
complications and secondary outcomes were obstetric complications. Main
Results Multivariate Cox proportional hazards regression revealed that
risk of preterm birth [hazard ratio (HR) 2.06, 95% confidence
interval (CI) 1.86-2.29], low birth weight (LBW) (HR 1.65, 95% CI
1.49-1.82), C/S (HR 1.14, 95% CI 1.09-1.19), gestational hypertension
(HR 1.36, 95% CI 1.19-1.56), and placenta previa (HR 1.57, 95% CI
1.33-1.87) was significantly higher in women who underwent non-obstetric
surgery during pregnancy compared to women who did not undergo such
surgery. When comparing the laparoscopic and laparotomy groups for risk
of fetal outcomes, the risk of LBW was significantly decreased in
laparoscopic adnexal resection during pregnancy compared to that of
laparotomy (HR 0.62, 95% CI 0.40-0.95). Conclusion: Non-obstetric
pelvic surgery during pregnancy was associated with higher risk of
preterm birth, LBW, gestational hypertension, placenta previa, placental
abruption, and C/S. Although the benefits and safety of laparoscopy
during pregnancy appear similar to those of laparotomy in pregnancy
outcomes, laparoscopic adnexal mass resection was associated with a
lower risk of LBW.