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Obstetrics
Antepartum nonobstetrical surgery at ≥23 weeks’ gestation and risk for preterm delivery

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Objective

We sought to describe the influence of antepartum nonobstetrical surgical procedures performed at viable fetal gestational ages (GAs) on incidence of preterm delivery.

Study Design

This was a retrospective case series of patients requiring nonobstetrical surgery at ≥23 weeks’ gestation at the Mayo Clinic during the interval 1992 through 2014. Data were abstracted for maternal demographic variables, operative procedure, anesthetic type, whether intraoperative fetal monitoring was employed, and both GA and method of delivery.

Results

In all, 111 patients underwent 121 operative procedures at a mean GA of 29.2 weeks (range, 23–37 weeks). The majority of procedures were completed under general anesthesia (88/121, 73%), with intraoperative fetal monitoring performed in 14 cases (14/121, 12%); fetal loss occurred during a single unmonitored procedure. Outcome data were available for the majority of patients (86/111, 78%) with preterm delivery occurring in 41% (35/86) at a mean GA of 36.9 weeks (range, 25–41 weeks). Mean interval from procedure to delivery was 7.7 weeks, with 9 patients (9/86, 10%) delivering within 1 week of surgery. Neither procedures requiring entry into the abdominal cavity (P = .65) nor GA at time of procedure (P = 1.0) statistically influenced the risk of preterm delivery.

Conclusion

Nonobstetrical surgical procedures performed at or beyond fetal viability increased the incidence of preterm delivery regardless of surgical site or timing of procedure, however the risk of intraoperative or immediate postoperative obstetrical complications was relatively low.

Section snippets

Materials and Methods

The Mayo Clinic Department of Obstetrics electronic database was reviewed to identify all patients undergoing a surgical procedure within 12 months of a documented pregnancy and/or delivery from January 1992 through March 2014. For study purposes, a GA of ≥23 weeks’ gestation was considered to represent the threshold of fetal viability in our institution. Each electronic medical record identified was reviewed to confirm an antepartum surgical procedure was performed, and then abstracted for

Results

During the 23-year study interval, approximately 36,100 patients were delivered at the Mayo Clinic in Rochester, MN. A total of 121 surgical procedures were performed in 111 patients at ≥23 weeks’ gestation, for an incidence of approximately 1 procedure per 325 pregnancies. Singleton gestations comprised 108 of the 111 pregnancies, with 3 twin pregnancies included. Multiple procedures were required in 8 patients during a single pregnancy, 5 of which were performed for recurrent urologic

Comment

Surgical procedures performed at or beyond fetal viability pose a relatively low risk of intraoperative or immediate postoperative obstetrical complications but appear to confer an increased risk of eventual preterm delivery. Study findings included 10% of patients undergoing nonobstetric surgery delivering within 1 week and 41% <37 weeks’ gestation, with a single recorded instance of possible intraoperative fetal demise. Subgroup analysis by procedural type and GA at time of surgery did not

References (9)

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The authors report no conflict of interest.

Cite this article as: Baldwin EA, Borowski KS, Brost BC, et al. Antepartum nonobstetrical surgery at ≥23 weeks’ gestation and risk for preterm delivery. Am J Obstet Gynecol 2015;212:232.e1-5.

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