Perioperative management and pregnancy outcome analysis for non-obstetric surgery during pregnancy: 87 case series

doi:10.3877/cma.j.issn.2095-3259.2020.01.012

Abstract

Abstract:

Objective

To investigate anesthesia methods, operation factors and infection factors effect on maternal and fetal outcome during non-obstetric surgery.

Methods

The clinical data of 87 pregnant women who needed surgical treatments for non-obstetric diseases from January 2015 to August 2018 in The Third Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. We documented their pregnancy outcome indexes such as gestational week, mode of delivery and premature birth rate. Then, the effects of different pregnancies, surgical methods, anesthetic methods and complications of infection on pregnant women′s were compared.

Results

There are 35 cases of acute appendicitis (40.2%), 7 cases of uterine pregnancy complicated with ectopic pregnancy (8.1%), 9 cases of ovarian cyst pedicle torsion (10.3%), 21 cases of ovarian mass (24.1%), 13 cases of Urinary calculi (14.9%) and 2 cases of cholecystolithiasis (2.3%). There were no significant differences in pregnancy outcome among pregnant women undergoing non-obstetric surgery during different pregnancies (P>0.05). There were no significant differences in mode of delivery, gestational age, abortion rate and premature delivery rate between laparoscopy group and abdomen group (P>0.05). There were no significant differences in mode of delivery, gestational age, premature delivery rate and abortion rate between intravertebral anesthesia group and general anesthesia group (P>0.05). The pregnant women with infection had an effect on the pregnancy outcome. The gestational age of the infected group was lower than that of the control group [(34.7±0.7) weeks vs (38.5±0.2) weeks, Z=5.088, P<0.05]. The incident rate of cesarean section, premature delivery and abortion in the infection group were all higher than those in the control group [41.7% (10/24) vs 31.7% (20/63), χ²=7.585; 50% (12/24) vs 7.9% (5/63), χ²=19.588; 50.0% (12/24) vs 0, χ²=29.659; all P<0.05].

Conclusions

Non-obstetric surgery during pregnancy still can achieve satisfactory pregnancy outcome in the stable patients, while different kind of anesthesia and operation in different gestation will not affect the safety of the puerperant and fetus, but the progress of the disease itself may affect the pregnancy outcome for the co-infection patient.

Key words: Pregnancy, Non-obstetric surgery, Pregnancy outcome, Perioperative management, Anaesthesia

Yafen Wu, Peng Tuo, Jinfa Liu, Shouping Wang. Perioperative management and pregnancy outcome analysis for non-obstetric surgery during pregnancy: 87 case series[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2020, 09(01): 54-58.

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Figures/Tables 5

References 15

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疾病名称	例数(%)	诊断孕周(周)	术前体温例(℃)	白细胞计数(×10⁹ /L)
急性阑尾炎	35(40.2%)	7^＋～30^＋	2例(38.3 ℃)，余正常	7.3～18.3
宫内合并宫外妊娠	7(8.1%)	5^＋～8^＋	正常	4.6～10.7
卵巢囊肿蒂扭转	9(10.3%)	5^＋～31^＋	1例(37.5 ℃)，余正常	4.8～13.7
卵巢肿物	21(24.1%)	6^＋～24^＋	正常	3.8～12.6
泌尿系结石	13(14.9%)	14^＋～34^＋	2例(38.2 ℃)，余正常	10.5～33.1
胆囊结石	2(2.3%)	22^＋～25^＋	正常	14.6～18.2
疾病名称	术中所见	SIRS评分(分)	分娩孕周(周)	分娩方式(例)		流产(例)	早产(例)
疾病名称	术中所见	SIRS评分(分)	分娩孕周(周)	剖宫产	顺产	流产(例)	早产(例)
急性阑尾炎	8例坏疽穿孔性阑尾炎	2～4	34^＋～37^＋	2	2	4	3
	27例水肿充血性阑尾炎	0～3	36^＋～40^＋	9	18	0	4
宫内合并宫外妊娠	1例腹腔积血300 ml	0～2	37^＋～41^＋	2	5	0	0
卵巢囊肿提扭转	1例坏死	0～2	33^＋～40^＋	3	6	0	2
卵巢肿物	2例恶性	0	39^＋～39^＋	2	0	0	0
	19例良性	0～4	18^＋～41^＋	4	14	1	1
泌尿系结石	10例输尿管梗阻	1～4	28^＋～38^＋	8	0	5	7
胆囊结石	胆囊水肿充血	2～3	39^＋	0	2	0	0

疾病名称	例数(%)	诊断孕周(周)	术前体温例(℃)	白细胞计数(×10⁹ /L)
急性阑尾炎	35(40.2%)	7^＋～30^＋	2例(38.3 ℃)，余正常	7.3～18.3
宫内合并宫外妊娠	7(8.1%)	5^＋～8^＋	正常	4.6～10.7
卵巢囊肿蒂扭转	9(10.3%)	5^＋～31^＋	1例(37.5 ℃)，余正常	4.8～13.7
卵巢肿物	21(24.1%)	6^＋～24^＋	正常	3.8～12.6
泌尿系结石	13(14.9%)	14^＋～34^＋	2例(38.2 ℃)，余正常	10.5～33.1
胆囊结石	2(2.3%)	22^＋～25^＋	正常	14.6～18.2
疾病名称	术中所见	SIRS评分(分)	分娩孕周(周)	分娩方式(例)		流产(例)	早产(例)
疾病名称	术中所见	SIRS评分(分)	分娩孕周(周)	剖宫产	顺产	流产(例)	早产(例)
急性阑尾炎	8例坏疽穿孔性阑尾炎	2～4	34^＋～37^＋	2	2	4	3
	27例水肿充血性阑尾炎	0～3	36^＋～40^＋	9	18	0	4
宫内合并宫外妊娠	1例腹腔积血300 ml	0～2	37^＋～41^＋	2	5	0	0
卵巢囊肿提扭转	1例坏死	0～2	33^＋～40^＋	3	6	0	2
卵巢肿物	2例恶性	0	39^＋～39^＋	2	0	0	0
	19例良性	0～4	18^＋～41^＋	4	14	1	1
泌尿系结石	10例输尿管梗阻	1～4	28^＋～38^＋	8	0	5	7
胆囊结石	胆囊水肿充血	2～3	39^＋	0	2	0	0

孕期分期	例数	分娩孕周(周) (±s)	分娩方式(例)		早产[例(%)]	流产[例(%)]
孕期分期	例数	分娩孕周(周) (±s)	剖宫产	顺产	早产[例(%)]	流产[例(%)]
孕早期	21	38.4±0.4	6	13	1(4.8)	2(9.5)
孕中期	52	37.9±0.4	18	26	10(19.2)	8(15.4)
孕晚期	14	36.6±0.9	6	8	6(42.9)	0
统计值		Z＝0.864	χ²＝0.760		χ²＝7.762	χ²＝2.672
P值		>0.05	>0.05		>0.05	>0.05

孕期分期	例数	分娩孕周(周) (±s)	分娩方式(例)		早产[例(%)]	流产[例(%)]
孕期分期	例数	分娩孕周(周) (±s)	剖宫产	顺产	早产[例(%)]	流产[例(%)]
孕早期	21	38.4±0.4	6	13	1(4.8)	2(9.5)
孕中期	52	37.9±0.4	18	26	10(19.2)	8(15.4)
孕晚期	14	36.6±0.9	6	8	6(42.9)	0
统计值		Z＝0.864	χ²＝0.760		χ²＝7.762	χ²＝2.672
P值		>0.05	>0.05		>0.05	>0.05

手术方式	例数	分娩孕周(周) (±s)	分娩方式(例)		早产[例(%)]	流产[例(%)]
手术方式	例数	分娩孕周(周) (±s)	剖宫产	顺产	早产[例(%)]	流产[例(%)]
腹腔镜	24	38.6±0.4	5	17	1(4.2)	2(8.3)
开腹	63	37.5±0.3	25	30	16(25.4)	8(12.7)
统计值		Z＝2.247	χ²＝2.733		χ²＝3.723	χ²＝0.263
P值		>0.05	>0.05		>0.05	>0.05

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