Intraabdominal surgery during pregnancy

Intraabdominal surgical disease during pregnancy can present a challenge in diagnosis and management for the obstetrician and surgeon. To examine the complications to the fetus and mother and the consequences of a delay in operative intervention, we retrospectively studied all pregnant patients over a 17-year period who had undergone abdominal surgery at one institution. A total of 92 abdominal operations were performed on 90 patients. During the same period, 41,532 deliveries occurred. One in 451 deliveries involved surgical procedures during pregnancy. Thirty-seven patients had surgery for acute appendicitis; 20 patients were operated on for ovarian abnormalities. Postoperatively, there were two maternal deaths: one from cardiac arrhythmia and the other from hepatic failure. The most common postoperative complication was premature labor (19 patients, 21 percent). In 16 of these patients, early tocolysis was begun without fetal loss. There were five fetal deaths. Forty-seven of 72 patients had term deliveries. Intraabdominal surgery during pregnancy carries an acceptable risk to the mother and fetus; complications are related to disease severity and operative delay rather than to the operative procedure itself.