Management of Non-obstetric Acute Abdomen During Pregnancy: A High Volume Maternity Center Experience

Abstract

Introduction:The objectives of this study are to analyse and present the cases of pregnant patients who were operated due to non-obstetrical causes, and discuss the ideal diagnostic and therapeutic approaches in the light of current literature.Methods:We retrospectively reviewed the medical records of pregnant patients who underwent surgery because of non-obstetric pathologies at our clinic between January 2013 and December 2019. Additionally, we evaluated the data of patients such as their demographics, gestational age, clinical and operative findings, diagnostic and therapeutic modalities, hospital stay time, maternal/foetal mortality, and morbidities.Results:The study cohort consisted of 52 patients who underwent non-obstetrical surgery. The patients’ mean age was 26.8±7.1 years. In total, 44% of all cases were in the second trimester. There were following indications for surgery among patients: acute appendicitis (AA) in 67%, acute biliary pancreatitis in 17%, acute cholecystitis in 4%, ovarian cyst rupture in 4% and other indications in 8% of patients. Laparoscopy was used in 35% of the operations, whereas 2% of the patients required postoperative intensive care unit support. Preterm delivery occurred in 6%, and miscarriage occurred in 2% of all cases. Foetal/maternal mortality was 2% in all cases. Moreover, 49% of AA cases were observed in the second trimester. Negative appendectomy rate was 9%. The number of perforated cases was six (17%). Five cases with perforated AA developed wound infection and were treated conservatively.Conclusion:Understanding anatomical and physiological changes in pregnancy, gaining sufficient information about the safe limits of radiological imaging, and a multidisciplinary systematic approach are indispensable for the timely diagnosis and treatment of pregnant women presenting with acute abdomen. Open or laparoscopic surgery for non-obstetric indications during pregnancy can be performed safely, without increases in maternal and foetal mortality, miscarriage, and preterm delivery rates.

Keywords

• non-obstetric surgery
• acute abdomen
• pregnancy
• acute pancreatitis
• acute appendicitis