Is Nonobstetric Surgery Harmful During Pregnancy?

Summary and Comment |
August 10, 2017

Is Nonobstetric Surgery Harmful During Pregnancy?

  1. Allison Bryant, MD, MPH

Risks are low for miscarriage, preterm birth, and cesarean delivery following non-OB surgery.

  1. Allison Bryant, MD, MPH

Although elective surgery during pregnancy is generally avoided, patients and providers may have concerns when the need for indicated, nonobstetric surgery arises during pregnancy. Counseling regarding the risks for adverse outcomes has been limited by older data, so National Health Service (NHS) investigators in England sought to evaluate such risk in a modern cohort.

Nonobstetric surgeries were performed in 0.7% of 6.4 million pregnancies identified in NHS hospitals from April 2001 through March 2012. The most common surgery types were abdominal (26%), dental (11%), nail/skin (10%), and orthopedic (10%). Surgeries were performed within a week of the end of pregnancy in fewer than 6% of cases. After adjustment for potential confounders, the number needed to harm (NNH) was 143 for miscarriage (i.e., 143 women would need to undergo nonobstetric surgery during pregnancy to cause 1 excess miscarriage), 287 for stillbirth, 31 for preterm birth, and 25 for cesarean delivery. Risks were higher in abdominal surgery in particular (e.g., NNH 20 for miscarriage).

Comment

Nonobstetric surgeries performed during pregnancy are generally safe. Of course, comparisons with what outcomes would have been if the underlying conditions remained untreated were not possible; it is likely that the indications for surgery themselves influence the likelihood of adverse outcomes. Although only miscarriages with hospitalization were recorded (and thus likely represent an underestimation of the overall miscarriage rate), I suggest that the message to patients and providers remains that pregnancy is not a contraindication to necessary surgery.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Editorial Boards Obstetrics and Gynecology; American Journal of Obstetrics and Gynecology; New England Journal of Medicine; Maternal and Child Health

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