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Salö M, Tiselius C, Rosemar A, Öst E, Sohlberg S, Andersson RE. Swedish national guidelines for diagnosis and management of acute appendicitis in adults and children. BJS Open 2025; 9:zrae165. [PMID: 40203150 PMCID: PMC11980984 DOI: 10.1093/bjsopen/zrae165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/19/2024] [Accepted: 12/15/2024] [Indexed: 04/11/2025] Open
Abstract
BACKGROUND Acute appendicitis is one of the most common causes of acute abdominal pain. Differences in the management of this large group of patients has important consequences for the patients and the healthcare system. Controversies regarding the understanding of the natural course of the disease, the utility of new diagnostic methods, and alternative treatments have lead to large variations in practice patterns between centres. These national guidelines present evidence-based recommendations aiming at a uniform, safe and cost-efficient management of this large group of patients. METHOD A working group of six experts with broad clinical and research experience was formed. Additional expertise from outside was consulted during the process. A national survey revealed significant variations in the management of patients with suspicion of appendicitis. The evidence provided in published guidelines and reviews were extracted and systematically graded, according to the GRADE methodology. This was supplemented by additional more recent and more directed search of the literature. Patients treated for appendicitis were involved through interviews. The guidelines were reviewed by external experts before the final version was determined. RESULTS The guidelines cover an extensive number of issues: pathology, epidemiology, aetiology, natural history, clinical and laboratory diagnosis, diagnostic scoring systems, diagnostic imaging, treatment, nursing care, follow-up, quality registers and quality indicators, among others. Special considerations related to children and pregnant women are covered. CONCLUSION These national guidelines present an extensive and thorough review of the current knowledge base related to appendicitis, and provide up-to-date evidence-based recommendations for the management of this large group of patients.
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Affiliation(s)
- Martin Salö
- Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden
| | - Catarina Tiselius
- Department of Surgery, Västmanland Hospital Västerås, Västerås, Sweden
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Anders Rosemar
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital Östra, Gothenburg, Sweden
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Sara Sohlberg
- Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | - Roland E Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
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Zayac AS, Egini O, Palmisiano ND, Evens AM. Lymphoma and leukemia occurring during pregnancy. Semin Perinatol 2025; 49:152041. [PMID: 40089320 DOI: 10.1016/j.semperi.2025.152041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2025]
Abstract
Malignancies arising during pregnancy are an infrequent occurrence, leading to a paucity of data on the optimal management of cancers during pregnancy. Unlike most solid tumors, the primary, and often curative, management of hematologic malignancies relies heavily on multiagent cytotoxic chemotherapies over surgery and other localized therapies, making their management during pregnancy even more complex and hazardous to both mother and fetus. Close multidisciplinary care and coordination between obstetrician, maternal fetal medicine, and oncologists are essential given the dangers to both in the management, from diagnosis and throughout treatment, even through delivery and survivorship. Due to the importance of this topic and the number of lives that could be impacted, guidelines have been published by interdisciplinary expert panels based on available data and clinical experience. This review addresses the management of both Hodgkin and non-Hodgkin lymphomas as well as acute and chronic leukemias. The optimal diagnostic approaches, and therapeutic schemes, including the use of cellular therapies, immunotherapies, targeted and cytotoxic agents, as well as guidance on decision making regarding management of the pregnancy weighing both the maternal and fetal risks and benefits of each approach are discussed herein.
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Affiliation(s)
- Adam S Zayac
- Division of Blood Disorders, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Ogechukwu Egini
- Division of Blood Disorders, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Neil D Palmisiano
- Division of Blood Disorders, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Andrew M Evens
- Division of Blood Disorders, Rutgers Cancer Institute, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Tang L, Angell TE. Thyroid cancer. Semin Perinatol 2025; 49:152042. [PMID: 40089326 DOI: 10.1016/j.semperi.2025.152042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2025]
Abstract
Thyroid cancer encountered during pregnancy requires a systematic approach balancing risks and benefits to both maternal and fetal health specific to this unique phase of life. Thyroid nodules are common and are predominantly evaluated to detect thyroid cancer. Clinical examination, serum thyroid stimulating hormone (TSH) measurement, ultrasonographic risk stratification, and fine needle aspiration biopsy when indicated are used to assess for malignancy. When thyroid cancer is diagnosed, further evaluation determines whether surgery during gestation is necessary or if delaying surgery until after delivery to minimize fetal and maternal risks is preferred. For patients who have undergone thyroidectomy for thyroid cancer, whether during pregnancy or before it, active management of levothyroxine therapy during pregnancy is recommended to ensure a sufficient thyroid hormone supply for both thyroid cancer treatment and optimal reproductive outcomes. This clinically oriented review summarizes key data, recommendations, and current trends regarding thyroid cancer care in pregnancy.
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Affiliation(s)
- Liyang Tang
- Assistant Professor of Clinical Otolaryngology-Head and Neck Surgery, Keck School of Medicine of USC, 1537 Norfolk St., Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Trevor E Angell
- Associate Professor of Clinical Medicine, Division of Endocrinology and Diabetes, Keck School of Medicine of USC, 1333 San Pablo Avenue, BMT-B11, Los Angeles, CA 90033, USA.
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Gao P, Hu X, Xia L, Chen J, Zhang X, Xu D, Tian L, Huang J. A retrospective study comparing maternal-infant outcome analysis of live births from patients undergoing painless oocyte retrieval versus conventional oocyte retrieval. BMC Pregnancy Childbirth 2025; 25:171. [PMID: 39962451 PMCID: PMC11834620 DOI: 10.1186/s12884-025-07266-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 01/31/2025] [Indexed: 02/20/2025] Open
Abstract
OBJECTIVE To investigate the maternal-infant outcomes of live births resulting from painless oocyte retrieval within assisted reproductive technology (ART). METHODS We conducted a retrospective cohort analysis of clinical data from patients who achieved live births through in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) at the Reproductive Medicine Center of Jiangxi Maternal and Child Health Hospital from September 2021 to May 2023. The study included 5,806 cycles of fresh embryo transfers during the early follicular phase prolonged protocol. Propensity score matching yielded 1,563 cases in both the painless oocyte retrieval group and the control group(the routine oocyte retrieval group). Univariate analysis was utilized to assess differences in basic clinical data, maternal complications, and neonatal birth outcomes. RESULTS There was no statistical significance between the two groups in terms of oocyte retrieval numbers, fertilization methods, matured ICSI oocytes, normal fertilized oocytes, normal cleavage oocytes, high-quality embryos, transferable embryos, ICSI oocyte maturation rates, normal fertilization rates, normal cleavage rates, high-quality embryo rates, transplantable blastocyst formation rates, rates of non-transplantable embryos, and fresh embryo transfer rates (all P > 0.05). Similarly, there were no significant differences in the number of embryos transferred, types of embryos transplanted, the presence of at least one high-quality embryo during transplantation, HCG positive rates, biochemical abortion rates, embryo implantation rates, clinical pregnancy rates, abortion rates, live birth rates, single fetus rates, and multiple pregnancy rates between the 2 groups (all P > 0.05). There were also no significant differences in gestational hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, placental abnormalities, polyhydramnios, oligohydramnios, cesarean section rates, and premature rupture of membranes between the groups (all P > 0.05). However, there was a statistically significant difference in the incidence of single live births larger than gestational age (P < 0.05). There was no statistically significant difference in sex distribution, preterm and very preterm birth rates, postmature birth rates, proportions of low birth weight, very low birth weight, giant infants, incidences of small for gestational age, and birth defects between the 2 groups (all P > 0.05). CONCLUSION The medication used in painless oocyte retrieval does not impact the fertilization of oocytes, follicular maturation, cleavage, or clinical pregnancy rates, nor does it increase the risk of maternal complications or birth defects in live births. These findings have important clinical implications for the safety of assisted reproductive technologies (ART). The observed results should be considered when counseling patients about the potential risks and benefits of ART, thus contributing to better - informed decisions and enhanced patient comfort.
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Affiliation(s)
- Pingping Gao
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China
| | - Xuyan Hu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China.
| | - Leizhen Xia
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China
| | - Junmin Chen
- Pediatric surgery, Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Xuehong Zhang
- Department of Urology Surgery, Nanchang County People's Hospital, Nanchang, China
| | - Dingfei Xu
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China
| | - Lifeng Tian
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China.
| | - Jialyu Huang
- Center for Reproductive Medicine, Jiangxi Maternal and Child Health Hospital, 318 Bayi Avenue, Nanchang, 330006, China
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Diaz JJ, Ceresoli M, Herron T, Coccolini F. Current management of acute appendicitis in adults: What you need to know. J Trauma Acute Care Surg 2025; 98:181-189. [PMID: 39504344 DOI: 10.1097/ta.0000000000004471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
ABSTRACT Acute appendicitis is one of the most common acute surgical diseases in the world today. Acute appendicitis can present with a well-recognized clinical presentation with abdominal pain which localize in the right lower quadrant. This presentation is more typical in men than in women of child baring age. Several clinical and laboratory calculations can be used to increase the likelihood of making a correct diagnosis. Various imaging modalities can be used to make the diagnosis which include ultrasound, computer tomography, and magnetic resonance imaging. Each study has well known sensitivity/specificity of positive predictive value of making the diagnosis of appendicitis. The management of acute appendicitis is based on the presentation of the patient and dividing it into uncomplicated and complicated disease. Each requires management with antibiotics and followed with timely appendectomy. Recent studies have demonstrated nonoperative management of uncomplicated appendicitis without no fecalith that can be managed with antibiotics alone. Complicated acute appendicitis should undergo timely surgical intervention. Patients presenting with a large appendiceal abscess or phlegmon should undergo percutaneous drainage and antibiotic management. There are certain patient populations that should be considered for surgical intervention. Pregnant patients as well as immunosuppressed patients should undergo timely surgical intervention to decrease the risk of complications. This review outlines the current principles of the diagnosis, imaging, and treatment of acute appendicitis based on the best available evidence of acute appendicitis in adults.
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Affiliation(s)
- Jose J Diaz
- From the Division of Acute Care Surgery (J.J.D.), Tampa General Hospital, University of South Florida, Tampa, Florida; School of Medicine and Surgery (M.C.), University of Milano-Bicocca; General and Emergency Surgery Department (M.C.), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; Tampa General Hospital (T.H.), University of South Florida, Tampa, Florida; and Department of General Emergency and Trauma Surgery (F.C.), Pisa University Hospital, Pisa, Italy
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Mills G, Shand A, Kennedy D, Lowe S, Bilsland V, Cutts B, McBride B, Brown W, Bolisetty S, Wegner EA, Kidson-Gerber G. Position statement on the diagnosis and management of acute leukaemia and aggressive lymphomas in pregnancy. Lancet Haematol 2025; 12:e151-e162. [PMID: 39761682 DOI: 10.1016/s2352-3026(24)00309-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/23/2024] [Accepted: 09/26/2024] [Indexed: 02/07/2025]
Abstract
Haematological malignancies affect 12·5 in 100 000 pregnancies. Over the past two decades, the number of haematological malignancies in pregnancy has substantially increased. Life-threatening haematological malignancies in pregnancy, such as acute leukaemia and aggressive lymphomas, pose a unique therapeutic challenge: clinicians must consider both maternal and fetal wellbeing, aiming to deliver optimal curative therapy for the patient and a successful pregnancy outcome. A multidisciplinary approach to disease management is paramount, and there are currently no clinical practice guidelines available. An Australasian working group, including representatives from haematology, obstetric medicine, clinical teratology, radiology, nuclear medicine, maternal-fetal medicine, and a patient representative, was established to develop this position statement, which is based on a combination of current evidence and expert consensus. We provide recommendations for diagnosis and staging, imaging safety in pregnancy, therapy in pregnancy incorporating a multidisciplinary approach, supportive care, oncofertility, and pregnancy and birth management. This Viewpoint was reviewed and endorsed by the councils of the Society of Obstetric Medicine of Australia and New Zealand, the Haematology Society of Australia and New Zealand, and the Haematology in Obstetric and Women's Health Collaborative.
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Affiliation(s)
- Georgia Mills
- Department of Haematology, Northern Beaches Hospital, Sydney, NSW, Australia; School of Medicine, Macquarie University, Sydney, NSW, Australia.
| | - Antonia Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, NSW, Australia
| | - Sandra Lowe
- Department of Obstetric Medicine, Royal Hospital for Women, Sydney, NSW, Australia; School of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Briony Cutts
- Department of Obstetric Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Western Health, Melbourne, VIC, Australia; Department of Haematology, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Bruce McBride
- Department of Nuclear Medicine and PET, Prince of Wales Hospital and Sydney Children's Hospital, Sydney, NSW, Australia
| | - Wendy Brown
- Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Srinivas Bolisetty
- Department of Neonatology, Royal Hospital for Women, Sydney, NSW, Australia
| | - Eva A Wegner
- School of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Nuclear Medicine and PET, Prince of Wales Hospital and Sydney Children's Hospital, Sydney, NSW, Australia
| | - Giselle Kidson-Gerber
- Department of Obstetric Medicine, Royal Hospital for Women, Sydney, NSW, Australia; School of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Department of Haematology, Prince of Wales Hospital and Sydney Children's Hospital, Sydney, NSW, Australia
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Baruch Y, Razdolsky S, Attali E, Anteby M, Yogev Y, Michaan N. The risk of preterm delivery after appendectomy during pregnancy is higher in the face of a negative appendectomy. Am J Surg 2025; 240:116120. [PMID: 39632335 DOI: 10.1016/j.amjsurg.2024.116120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 10/19/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Reported outcomes after appendectomy during pregnancy remain inconclusive, and the risk for preterm delivery is not necessarily procedure-related. METHODS This retrospective cohort study included 185 pregnant women who underwent appendectomy during pregnancy and gave birth between 2005 and 2022, compared using a 3:1 ratio to 555 parturients who did not undergo surgery. clinical, obstetrical and neonatal outcomes were analyzed. RESULTS Laparoscopic appendectomy was the most common procedure (117/185; 63.2 %) whereas 68/185 (36.8 %) had open appendectomy. Pathological findings revealed that 141/185 cases (76.2 %) had an inflamed appendix, while 44/185 (23.8 %) were classified as having a "white appendix" (negative appendectomy). Preterm delivery occurred more frequently in the appendectomy group [22/185 (11.9 %) vs 30/555 (5.4 %), p = 0.003] with even higher incidence in negative appendectomies compared to inflamed appendix cases [9/44 (20.5 %) vs 13/141 (9.2 %), p = 0.044]. Multivariate analysis identified appendectomy (but not an inflamed appendix) as the sole significant risk factor for preterm birth (odds ratio 2.3, CI 1.26-4.15, p = 0.006). CONCLUSION Preterm delivery correlates with negative appendectomies. Careful assessment is essential to avoid unnecessary surgical interventions during pregnancy.
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Affiliation(s)
- Yoav Baruch
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
| | - Sabina Razdolsky
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
| | - Emmanuel Attali
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
| | - Matan Anteby
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
| | - Nadav Michaan
- Department of Obstetrics and Gynecology, Lis Maternity and Women's Hospital, Sourasky Medical Center, Faculty of Medicine Tel Aviv University, Weizmann 6 Street Tel Aviv, Israel.
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Pecorella G, Sparic R, Morciano A, Constantin SM, Babovic I, de Rosa F, Tinelli A. Mastering nonobstetric surgery in pregnancy: Insights, guidelines evaluation, and point-by-point discussion. Int J Gynaecol Obstet 2025; 168:472-483. [PMID: 39224999 DOI: 10.1002/ijgo.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
For surgeons and clinicians, nonobstetric surgery during pregnancy has certain difficulties and considerations. In order to aid in decision-making in these situations, this manuscript offers a thorough review of the guidelines currently in place from renowned obstetric and surgical societies, such as the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians & Gynecologists, and others. Using AGREE II-S methodology, a comprehensive analysis of guidelines reveals differences in recommendations for anesthetics, surgical procedures, imaging modalities, and thromboembolic prophylaxis. Furthermore, a thorough discussion of strategic surgical planning is provided, covering aspects such as patient positioning, trocar placement, pneumoperitoneum generation, and thromboembolic risk management. The publication highlights that in order to maximize the results for both the mother and the fetus after nonobstetric surgery performed during pregnancy, a multidisciplinary approach and evidence-based decision-making are essential.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Morciano
- Department of Obstetrics and Gynaecology, Pia Fondazione Cardinale G. Panico, Tricase, Italy
| | - Silviu Mihai Constantin
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Ivana Babovic
- Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Filippo de Rosa
- Department of Anesthesia and Intensive Care, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Scorrano, Lecce, Italy
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Czesla D, Felcht M. [Dermatologic surgery during pregnancy and lactation]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:852-863. [PMID: 39387862 DOI: 10.1007/s00105-024-05418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/12/2024]
Abstract
It may be necessary for patients to undergo (dermato-)surgical procedures during pregnancy or lactation. Often, there are no drug approvals or guidelines in this context. The following article describes the most common dermatologic surgical conditions during pregnancy and lactation, as well as the special therapeutic considerations and risks to be aware of during treatment. Dermatosurgical procedures are subject to strict indications. Most of these procedures can be performed during pregnancy, but the risks to the mother and fetus must be carefully weighed against the disadvantages of nonsurgical therapy. Although surgery can be performed safely in any trimester, the second trimester and immediate postpartum period are optimal. Surgery should not be delayed for melanoma or high-risk skin cancer. Perioperative positioning and choice of analgesics, antiseptics, anesthetics and antibiotics must be considered carefully to avoid risks to the patient, fetus and infant.
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Affiliation(s)
- Daniel Czesla
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus, Akademisches Lehrkrankenhaus, Medizinische Fakultät Mannheim, Universität Heidelberg, Landhausstr. 25, 69115, Heidelberg, Deutschland
| | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus, Akademisches Lehrkrankenhaus, Medizinische Fakultät Mannheim, Universität Heidelberg, Landhausstr. 25, 69115, Heidelberg, Deutschland.
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Liang Y, Zhu M, Zhang D, Xia W, Yu Y, Liu X, Zhang J. Evaluation of laparo-endoscopic single-site surgery for adnexal mass in pregnant women. BMC Pregnancy Childbirth 2024; 24:647. [PMID: 39367375 PMCID: PMC11451005 DOI: 10.1186/s12884-024-06829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 09/13/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Surgery for adnexal mass does occur in pregnant women and therefore the choice of surgery during pregnancy needs to be carefully considered and studied. This study aimed to evaluate the safety and feasibility of Laparo-endoscopic Single-site Surgery (LESS) for adnexal mass during pregnancy and investigate the perioperative condition, pregnancy complications, and obstetric outcomes of operative women during pregnancy. METHODS This study retrospectively collected medical records and surgery videos of 20 pregnant women who underwent LESS for adnexal mass between November 2019 and January 2022. Baseline characteristics, operative-related variables, and pregnancy outcomes were followed up. RESULTS LESS for adnexal mass was successfully performed in 20 pregnant women, with very satisfactory surgery outcomes reported in all cases. The average gestational age at operation was 15+2 weeks (range, 5+1- 25+4 weeks). The median operative time was 80.8 min (range, 40 -185 min) and the average operative bleeding was 28.0 ml (range, 10-50 ml). The average VAS of 24 h postoperatively was 1 (range, 0-2), and the average length of hospital stay was 5.15 days (range, 3-7 days). All these women delivered a healthy newborn at full term except 1 woman induced abortion for her own reasons at 16+5 weeks gestational age (GA). The average GA of delivery was 39+1 weeks (range, 37-40+1 weeks), the average birth weight was 3228.95 g (range, 2740-3930 g), and the average Apgar score at 5 min was 9.95 (range, 9-10). CONCLUSIONS LESS for adnexal mass is safe and feasible for pregnant women.
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Affiliation(s)
- Yan Liang
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Minjiao Zhu
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Duo Zhang
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Wei Xia
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Yingying Yu
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Xiaoyi Liu
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Jian Zhang
- Department of Obstetrics and Gynecology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
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Eli S, Gal SG, Adnan Z. Comparison between surgical and non-surgical management of primary hyperparathyroidism during pregnancy: a systematic review. Endocrine 2024; 86:101-108. [PMID: 38918290 PMCID: PMC11445326 DOI: 10.1007/s12020-024-03930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE The management of primary hyperparathyroidism (PHPT) during pregnancy may be surgical or conservative. This study compared adverse outcomes between surgical and non-surgical treatments. Additionally, the study investigated the correlation between serum calcium values and complication rates. METHODS A systematic review of retrospective studies, case series, and case reports. Biochemical parameters, interventions, and outcomes of each pregnancy were recorded. The study population comprised two groups: the non-surgical and surgical groups. Adverse outcomes were categorized as maternal, obstetric, or neonatal. RESULTS The surgical and non-surgical groups consisted of 163 and 185 patients, respectively. A positive correlation was observed between the mean maternal gestational calcium value and both maternal and obstetric complication. Neonatal complications were more prevalent in patients treated conservatively across all maternal calcium values (p < 0.001). No significant differences were observed in maternal outcomes and overall obstetric outcomes between the study groups, albeit a higher mean serum calcium value in the surgical group (12.3 mg/dL) compared with the non-surgical group (11.1 mg/dL). CONCLUSIONS Given the significantly lower neonatal adverse outcomes in the surgical group compared to the non-surgical group, along with non-inferior maternal and obstetric outcomes in the surgical group, the overall data of this study suggest that parathyroidectomy is favorable to non-surgical management even in cases of mild hypercalcemia.
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Affiliation(s)
- Shezifi Eli
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel
- Laniado Hospital, Netanya, Israel
| | - Shlomo Gozlan Gal
- Department of Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zaina Adnan
- Bar-Ilan University, The Azrieli Faculty of Medicine, Safed, Israel.
- Division of Endocrinology and Metabolism, Clalit Medical Health Care Services, Haifa and Western Galilee District, Zvulon Medical Center, Haifa, Israel.
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12
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Moltubak E, Landerholm K, Blomberg M, Andersson RE. Validation of the Appendicitis Inflammatory Response (AIR) score during pregnancy: A nested case-control study. Acad Emerg Med 2024; 31:894-902. [PMID: 38597185 DOI: 10.1111/acem.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Appendicitis poses diagnostic challenges. A correct diagnosis is important during pregnancy to avoid unnecessary surgery on the one hand and delayed surgery on the other hand, as both may negatively affect pregnancy outcomes. Clinical scores for risk-stratified management of suspected appendicitis are well established in adults but have not been validated during pregnancy. This nested case-control study evaluated the diagnostic accuracy of the Appendicitis Inflammatory Response (AIR) score and imaging during pregnancy. METHODS By cross-linking national Swedish health registries from a defined geographical area, we identified a cohort of 154 women who underwent appendectomy for suspected appendicitis during pregnancy and a matched cohort of 232 pregnant women admitted for acute abdominal pain and suspected appendicitis but with a discharge diagnosis of nonspecific abdominal pain (NSAP). All variables were extracted from medical records. The diagnostic value of AIR score and imaging was estimated for patients with a final diagnosis of appendicitis compared with patients with negative appendectomy and NSAP patients. RESULTS The final diagnoses for the operated patients were uncomplicated and complicated appendicitis in 49.4% and 26.6%, respectively, and negative appendectomy in 24.0%. Nearly half of all the patients underwent diagnostic imaging (41%), mainly by ultrasonography. The sensitivity and specificity of diagnostic imaging were 44.9% (95% CI 32.9%-57.4%) and 42.2% (95% CI 31.9%-53.1%), respectively. The area under the receiver operating characteristic curve of AIR score was 0.88 (95% CI 0.84-0.92) for all appendicitis and 0.90 (95% CI 0.84-0.95) for complicated appendicitis. The sensitivity for complicated appendicitis was 100% at a score of ≥4. The specificity for all appendicitis was 97% at a score of ≥9. CONCLUSIONS The results of this study suggest that the AIR score may be a suitable diagnostic tool for risk stratification of pregnant women with abdominal pain and suspected appendicitis but further validation among pregnant women is needed.
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Affiliation(s)
- Elin Moltubak
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Kalle Landerholm
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Marie Blomberg
- Department of Surgery, County Hospital Ryhov, Jönköping, Sweden
- Department of Obstetrics and Gynecology, Linköping University Hospital, Linköping, Sweden
| | - Roland E Andersson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Futurum Academy for Health and Care, Jönköping County Council, Jönköping, Sweden
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13
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Delgado C, Davies J. Ethical Care of Pregnant Patients During Labor, Delivery, and Nonobstetric Surgery. Anesthesiol Clin 2024; 42:503-514. [PMID: 39054023 DOI: 10.1016/j.anclin.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The 4 basic principles of ethics (beneficence, nonmaleficence, autonomy, and justice) can guide clinical decision-making for the pregnant patient during labor and delivery, as well as when undergoing nonobstetric surgery. An evidence-based decision-making conversation with the patient facilitates obtaining informed consent. When maternal-fetal conflict arises, both during labor and delivery and nonobstetric surgery, beneficence-based obligations to both parties should be considered, with discussions and decisions well documented. Labor is not an impediment to women providing consent for care. A careful balance between evidence-based clinical judgment and patient autonomy is necessary when addressing cesarean delivery.
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Affiliation(s)
- Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Northeast Pacific Street, Box 356540, Seattle WA 98195, USA.
| | - Jo Davies
- Department of Anesthesiology and Pain Medicine, University of Washington, University of Washington Medical Center, 1959 Northeast Pacific Street, Box 356540, Seattle WA 98195, USA
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14
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Liu H, Xie W, Gong W. Gastric cancer in pregnancy: a review. Future Oncol 2024; 20:1851-1860. [PMID: 39041597 PMCID: PMC11486268 DOI: 10.1080/14796694.2024.2370236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/17/2024] [Indexed: 07/24/2024] Open
Abstract
Malignant tumors including gastric cancer (GC) are the leading cause of deaths among reproductive women. Physiological morning sickness can mask the clinical manifestations of GC, whereas the clinical presence of metastatic tumors in the abdominal cavity may be easily mistaken for abdominal swelling caused by fetal growth. Pregnancy and delivery processes in young females could accelerate the growth of GC, leading to its rapid development and grave prognosis. Therefore, early diagnosis is critical and gastrointestinal endoscopy is recommended for any suspected pregnant woman with long-term morning sickness. Treatment strategies, including chemotherapy, resection surgery and radiotherapy, will be determined based on a comprehensive consideration of the status of both the fetus and the mother. Rational management, especially clinical multidisciplinary collaboration may significantly benefit such patients.
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Affiliation(s)
- Hongming Liu
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
| | - Weixun Xie
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
| | - Weihua Gong
- Department of Surgery, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou310058, China
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15
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Zeleke ME, Chekol WB, Kasahun HG, Mekonnen ZA, Filatie TD, Melesse DY, Admassie BM, Admass BA. Perioperative management of surgical procedure during pregnancy: a systematic review. Ann Med Surg (Lond) 2024; 86:3432-3441. [PMID: 38846888 PMCID: PMC11152784 DOI: 10.1097/ms9.0000000000002057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 06/09/2024] Open
Abstract
Background Approximately 1-2% of pregnant women undergo non-obstetric surgery under anaesthesia during their pregnancy. This review specifically targets anaesthesia management for pregnant women undergoing non-obstetric surgery in resource-limited settings. Methods Following the delineation of primary questions, scope, and inclusion criteria, a comprehensive search strategy utilizing advanced techniques was implemented across electronic sources, databases, and websites to identify relevant articles. A rigorous screening process was applied during the literature evaluation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement guided the conduct of this review, ensuring adherence to standardized reporting practices. Results A total of 240 articles were initially identified from databases and websites. After screening titles and abstracts, 85 papers were excluded, and an additional 43 were removed due to duplication. Subsequently, 68 items were subjected to eligibility screening. Finally, 30 papers that specifically addressed anaesthetic considerations for pregnant women undergoing non-obstetric operations were reviewed. Conclusion Thorough preoperative evaluation is essential for all patients, with particular attention to modifications in anaesthetic management to accommodate physiological changes during pregnancy. Urgent and emergent surgeries should proceed promptly during pregnancy to optimize outcomes for both the mother and foetus. Maintaining uteroplacental perfusion generally involves avoiding maternal hypoxaemia, hypotension, hyper- and hypocapnia, temperature extremes, and stress. When deemed safe, regional anaesthesia may offer favourable outcomes for both the mother and foetus.
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Affiliation(s)
| | | | | | | | | | | | - Belete Muluadam Admassie
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Jackson S, Hunter J, Van Norman GA. Ethical Principles Do Not Support Mandatory Preanesthesia Pregnancy Screening Tests: A Narrative Review. Anesth Analg 2024; 138:980-991. [PMID: 37801601 DOI: 10.1213/ane.0000000000006669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
Respect for patient autonomy is a pillar of medical ethics, manifested predominantly through informed consent. Mandatory (routine) nonconsented preoperative urine pregnancy testing does not adequately respect patient autonomy, is potentially coercive, and has the potential to cause harm medically, psychologically, socially, and financially. Inaccuracies in pregnancy testing can result in false-positive and false-negative results, especially in early pregnancy. There is substantial scientific evidence that anesthesia is not harmful to the fetus, raising the question of whether pregnancy testing provides substantial benefit to the patient. Not performing a preanesthesia pregnancy test has not been associated with significant medicolegal consequences. We review the ethical implications of mandatory preanesthesia pregnancy testing in light of these facts.
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Affiliation(s)
- Stephen Jackson
- Department of Anesthesiology, Good Samaritan Hospital, San Jose, California
| | - James Hunter
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gail A Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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17
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Kummer J, Koenigbauer J, Peters FSJ, Rickert C, Hellmeyer L. Is Appendectomy During Late Stages of Pregnancy Associated with an Increased Cesarean Delivery Rate? - a Retrospective Analysis of One Center During 10 Years. Geburtshilfe Frauenheilkd 2024; 84:378-386. [PMID: 38618579 PMCID: PMC11006560 DOI: 10.1055/a-2273-2672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction About one in 500 pregnant women requires a surgical intervention that is not pregnancy-related. One of the most common surgical interventions during pregnancy is appendectomy. The primary aim of this study was to assess surgical access of appendectomy during pregnancy and pregnancy outcome. Secondary outcomes were clinical symptoms and diagnostics as well as histopathological analysis. Methods and Material This is a single-center retrospective data analysis conducted at a tertiary perinatal center. A digital search of the hospital record archive was conducted focusing on pregnant women beyond 24 0/7 weeks of pregnancy encoding appendectomy. Descriptive statistical analysis was performed. Results Between January 2013 and January 2023, a total of 20 appendectomies were performed during pregnancy with gestational age beyond 24 0/7 weeks of pregnancy. All of them were performed as lower midline laparotomy. The rate of appendix perforation was 3/20 (15.0%). 19/20 patients (95.0%) delivered via cesarean. In 7/20 patients (35.0%) appendectomy was performed during cesarean delivery due to incidental finding of irritated or abnormal vermiform appendix. In the pathological work-up, only 2/7 (28.6%) of these subjects had inflammation. Conclusion In this small monocentric cohort, only open appendectomies were performed. Our data indicate that it is safe to perform open appendectomy during pregnancy if necessary. In this small patient group, there was an increase in simultaneous cesarean deliveries.
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Affiliation(s)
- Julia Kummer
- Department of Obstetrics and Gynecology, Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Christian Rickert
- Department of Pathology, Klinikum im Friedrichshain, Berlin, Germany
| | - Lars Hellmeyer
- Department of Obstetrics and Gynecology, Klinikum im Friedrichshain, Berlin, Germany
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18
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Traweek R, Phan V, Griesbach C, Hall C. General Surgery During Pregnancy and Gynecologic Emergencies. Surg Clin North Am 2023; 103:1217-1229. [PMID: 37838464 DOI: 10.1016/j.suc.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Nonobstetrical surgical emergencies can occur throughout pregnancy but are often difficult to diagnose due to the physiologic and anatomical changes that occur during pregnancy. Medical providers should have insight into these changes and be familiar with options for the diagnosis and management of common nonobstetrical surgical emergencies, such as appendicitis, cholecystitis, and small bowel obstruction. Surgeons should also be aware of obstetrical emergencies, such as ectopic pregnancy and severe vaginal bleeding, which may be life threatening to mother and the fetus. Intraoperatively, surgeons should be familiar with minimally invasive approaches for surgical diseases and special anesthetic considerations for pregnant patients.
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Affiliation(s)
- Raymond Traweek
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Vivy Phan
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Griesbach
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA
| | - Chad Hall
- Baylor Scott & White Medical Center, 2401 South 31st Street, Temple, TX 76508, USA.
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19
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Haataja A, Kokki H, Uimari O, Kokki M. Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review. Scand J Surg 2023; 112:187-205. [PMID: 37329286 DOI: 10.1177/14574969231175569] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes. METHODS A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates. RESULTS We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0). CONCLUSIONS The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.
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Affiliation(s)
- Anna Haataja
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Outi Uimari
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Merja Kokki
- Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
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20
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Bista A, Mishra D, Ghimire S, Bhandari P, Puri S. Non-functioning Pituitary Macroadenoma Resection in Twin Pregnancy: A Case Report. Cureus 2023; 15:e42891. [PMID: 37664278 PMCID: PMC10474784 DOI: 10.7759/cureus.42891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Non-functioning pituitary adenomas (NFPAs) are rare in females of reproductive age. We present the case of a 37-year-old pregnant woman in her second trimester with a diagnosis of symptomatic pituitary macroadenoma with twin pregnancy. Magnetic resonance imaging (MRI) confirmed a well-defined macroadenoma compressing the optic chiasm, thus necessitating surgery. The patient underwent transnasal transsphenoidal resection of the tumor under general anesthesia. Anesthesia management posed challenges due to concurrent considerations of pregnancy and neurosurgery. Induction, maintenance, monitoring, and fluid management were carefully performed. The patient experienced a transient decrease in oxygen saturation, which improved with lung recruitment maneuvers. The surgery was successful without any complications. Postoperatively, an ophthalmology consultation was done, which showed an improvement in the patient's vision, as evidenced by the perimetry findings. Later, she delivered healthy twins at 36 weeks and six days of gestation. This case highlights the importance of a multidisciplinary approach and meticulous anesthetic management when dealing with pregnant patients undergoing non-obstetric surgery, ensuring optimal maternal-fetal perfusion and minimizing risks to both the mother and the fetus.
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Affiliation(s)
- Anup Bista
- Anesthesia and Critical Care, Patan Academy of Health Sciences, Kathmandu, NPL
| | - Dipesh Mishra
- Intensive Care Unit, Chirayu National Hospital and Medical Institute, Kathmandu, NPL
| | - Suson Ghimire
- Anesthesia and Critical Care, Patan Academy of Health Sciences, Kathmandu, NPL
| | | | - Sudan Puri
- Obstetrics and Gynaecology, Pyuthan Hospital, Pyuthan, NPL
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21
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Cusimano MC, Liu J, Azizi P, Zipursky J, Sajewycz K, Sussman J, Kishibe T, Wong E, Ferguson SE, D'Souza R, Baxter NN. Adverse Fetal Outcomes and Maternal Mortality Following Nonobstetric Abdominopelvic Surgery in Pregnancy: A Systematic Review and Meta-analysis. Ann Surg 2023; 278:e147-e157. [PMID: 34966066 DOI: 10.1097/sla.0000000000005362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To quantify the absolute risks of adverse fetal outcomes and maternal mortality following nonobstetric abdominopelvic surgery in pregnancy. SUMMARY BACKGROUND DATA Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking. METHODS We systematically searched MEDLINE, EMBASE, and EvidenceBased Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing nonobstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using a generalized linear random/mixed effects model with a logit link. RESULTS We identified 114 observational studies (52 [46%] appendectomy, 34 [30%] adnexal, 8 [7%] cholecystectomy, 20 [17%] mixed types) reporting on 67,111 pregnant patients. Overall pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.8% (95% CI 2.2-3.6), 9.7% (95% CI 8.3-11.4), and 0.04% (95% CI 0.02-0.09; 4/10,000), respectively. Rates of fetal loss and preterm birth were higher for pelvic inflammatory conditions (eg, appendectomy, adnexal torsion) than for abdominal or nonurgent conditions (eg, cholecystectomy, adnexal mass). Surgery in the second and third trimesters was associated with lower rates of fetal loss (0.1%) and higher rates of preterm birth (13.5%) than surgery in the first and second trimesters (fetal loss 2.9%, preterm birth 5.6%). CONCLUSIONS Absolute risks of adverse fetal outcomes after nonobstetric abdom- inopelvic surgery vary with gestational age, indication, and acuity. Pooled estimates derived here identify high-risk clinical scenarios, and can inform implementation of mitigation strategies and improve preoperative counselling.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Jessica Liu
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
| | - Paymon Azizi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
| | - Jonathan Zipursky
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katrina Sajewycz
- School of Medicine, Faculty ofHealth Sciences, Queen's University, Kingston, ON, Canada
| | - Jess Sussman
- School of Medicine, Faculty ofMedicine, University of Toronto, Toronto, ON, Canada
| | - Teruko Kishibe
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Health Sciences Library, St. Michael's Hospital, Toronto, ON, Canada
| | - Eric Wong
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Gynecologic Oncology, Princess Margaret Cancer Centre/Sinai Health Systems, Toronto, ON, Canada
| | - Rohan D'Souza
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada
- Division of Maternal Fetal Medicine, Mount Sinai Hospital/Sinai Health Systems, Toronto, ON, Canada
| | - Nancy N Baxter
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School ofPublic Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne ViC, Australia
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22
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Constantin A, Constantin R, Achim F, Socea B, Predescu D. Pregnancy and Gastric Cancer: A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13111909. [PMID: 37296761 DOI: 10.3390/diagnostics13111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30-39 years (and not exceptionally 40-49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due to the overlap between neoplasm symptomatology and the clinical picture of pregnancy. A paraclinical evaluation may also be difficult depending on the trimester of the pregnancy. Diagnosis is also delayed by practitioners' hesitation to use invasive investigations (imaging, endoscopy, etc.) due to fetal safety concerns. Therefore, digestive cancers are often diagnosed during pregnancy in advanced stages, where complications such as occlusions, perforations, and cachexia have already arisen. In this review, we highlight the epidemiology, clinical aspects, paraclinical evaluation, and particularities of the diagnosis and treatment of gastric cancer during pregnancy.
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Affiliation(s)
- Adrian Constantin
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Roxana Constantin
- Department of Obstetrics and Gynecology, Sanador Hospital, 010991 Bucharest, Romania
| | - Florin Achim
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Bogdan Socea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Department of Surgery, Sf. Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania
| | - Dragos Predescu
- Department of Esophageal and General Surgery, Sf. Maria Clinical Hospital Bucharest, 011192 Bucharest, Romania
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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23
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Crown A, McCartan D, Curry MA, Patil S, Kamer S, Goldfarb S, Gemignani ML. Pregnancy-associated breast cancer: does timing of presentation affect outcome? Breast Cancer Res Treat 2023; 198:283-294. [PMID: 36662395 DOI: 10.1007/s10549-022-06833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/01/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) comprises breast cancer diagnosed during the gestational period or within 12 months postpartum. While the incidence of PABC appears to be increasing, data regarding prognosis remain limited. METHODS Here we evaluate clinicopathologic features, treatments, and clinical outcomes among women with stage 0-III PABC diagnosed between 1992 and 2020. Comparisons were made between women who were diagnosed with PABC during gestation and those who were diagnosed within 12 months postpartum. RESULTS A total of 341 women were identified, with a median age of 36 years (range 25-46). The pregnancy group comprised 119 (35%) women, while 222 (65%) women made up the postpartum group. Clinicopathologic features were similar between groups, with most patients being parous and presenting with stage I and II disease. Treatment delays were uncommon, with a median time from histologic diagnosis to treatment of 4 weeks for both groups. Recurrence-free survival was similar between groups: 67% at 10 years for both. While 10-year overall survival appeared higher in the postpartum group (83% versus 78%, p = 0.02), only the presence of nodal metastases was associated with an increased risk of death (hazard ratio 5.61, 95% CI 2.20-14.3, p < 0.001), whereas timing of diagnosis and receptor profile did not reach statistical significance. CONCLUSION Clinicopathologic features of women with PABC are similar regardless of timing of diagnosis. While 10-year recurrence-free survival is similar between groups, 10-year overall survival is higher among women diagnosed postpartum; however, timing of diagnosis may not be the driving factor in determining survival outcomes.
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Affiliation(s)
- Angelena Crown
- Department of Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Damian McCartan
- Department of Breast Surgery, St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Michael A Curry
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sujata Patil
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sabrina Kamer
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, USA
| | - Shari Goldfarb
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Mary L Gemignani
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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24
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Surgical Emergencies in the Pregnant Patient. Curr Probl Surg 2023; 60:101304. [PMID: 37169419 DOI: 10.1016/j.cpsurg.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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25
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Brakke B, Sviggum H. Anaesthesia for non-obstetric surgery during pregnancy. BJA Educ 2023; 23:78-83. [PMID: 36844444 PMCID: PMC9947972 DOI: 10.1016/j.bjae.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/15/2023] Open
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26
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Gastrointestinal malignancies in pregnancy. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1709-1723. [PMID: 36607401 DOI: 10.1007/s00261-022-03788-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 01/07/2023]
Abstract
Gastrointestinal malignancies, though uncommon in pregnancy, present several unique challenges with regards to diagnosis, staging, and treatment. Imaging the pregnant patient with a suspected or confirmed GI malignancy requires modifications to the radiologic modality of choice and protocol in order to minimize harm to the fetus, ensure accuracy in diagnosis and staging and guide treatment decisions. In this review article, we discuss the imaging approach to the pregnant patient with GI cancer, including safe radiologic modalities and modifications to imaging protocols. We also review the most common GI cancers encountered in pregnancy, including colorectal, pancreatic, gastric, and small bowel tumors, with emphasis to imaging findings, staging, and treatment considerations.
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27
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Ukhanov AP, Zakharov DV, Zhilin SA, Bolshakov SV, Muminov KD, Aselderov YA. [Laparoscopic appendectomy for acute appendicitis in pregnancy]. Khirurgiia (Mosk) 2023:86-94. [PMID: 37707337 DOI: 10.17116/hirurgia202309186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.
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Affiliation(s)
- A P Ukhanov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - D V Zakharov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - S A Zhilin
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
- Jaroslav the Wise Institute of Medical Education of Novgorod State University, Veliky Novgorod, Russia
| | - S V Bolshakov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - K D Muminov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
| | - Yu A Aselderov
- Veliky Novgorod City Central Clinical Hospital, Veliky Novgorod, Russia
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Zaleski KL, Blazey MH, Carabuena JM, Economy KE, Valente AM, Nasr VG. Perioperative Anesthetic Management of the Pregnant Patient With Congenital Heart Disease Undergoing Cardiac Intervention: A Systematic Review. J Cardiothorac Vasc Anesth 2022; 36:4483-4495. [PMID: 36195521 DOI: 10.1053/j.jvca.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/11/2022]
Abstract
Maternal congenital heart disease is increasingly prevalent, and has been associated with a significantly increased risk of maternal, obstetric, and neonatal complications. For patients with CHD who require cardiac interventions during pregnancy, there is little evidence-based guidance with regard to optimal perioperative management. The periprocedural management of pregnant patients with congenital heart disease requires extensive planning and a multidisciplinary teams-based approach. Anesthesia providers must not only be facile in the management of adult congenital heart disease, but cognizant of the normal, but significant, physiologic changes of pregnancy.
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Affiliation(s)
- Katherine L Zaleski
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Jean M Carabuena
- Department of Anesthesiology, Perioperative and Pain Medicine-Brigham and Women's Hospital, Harvard Medical School, Boston MA
| | - Katherine E Economy
- Division of Maternal-Fetal Medicine, Brigham, and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anne M Valente
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care, and Pain Medicine-Boston Children's Hospital, Harvard Medical School, Boston, MA.
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29
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Chew KKY, Quah S, Boot MR, Sowter S. Management of urachal cancer in pregnancy: A systematic review. BJUI COMPASS 2022; 3:410-414. [PMID: 36267206 PMCID: PMC9579884 DOI: 10.1002/bco2.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/01/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Urachal cancer is a rare non-urothelial malignancy that involves the urachus, often occurring at the junction of the urachal ligament and the bladder dome. It accounts for less than 1% of all bladder tumours. Cancer during pregnancy is rare, with the incidence of all cancers in pregnancy estimated to be 25-27 per 100 000 pregnancies. Urachal cancer in pregnancy is an even rarer phenomenon, with only a handful of case reports published to date. After a systematic review, only five cases have been reported in the English literature. We aim to review the cases presented in the literature and to examine the outcomes of the management of urachal cancer in pregnancy to date.
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Affiliation(s)
- Kenneth K. Y. Chew
- University of New South WalesSydneyNew South WalesAustralia
- Wagga Wagga Base HospitalWagga WaggaNew South WalesAustralia
| | | | - Madison R. Boot
- Wagga Wagga Base HospitalWagga WaggaNew South WalesAustralia
| | - Steven Sowter
- University of New South WalesSydneyNew South WalesAustralia
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30
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“To Do or Not to Do, That Is the Question”, Surgery and Pregnancy. J Clin Med 2022; 11:jcm11175095. [PMID: 36079024 PMCID: PMC9457438 DOI: 10.3390/jcm11175095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
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31
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Surgical and obstetric outcomes of breast cancer surgery during pregnancy: a nationwide database study in Japan. Breast Cancer Res Treat 2022; 195:289-299. [PMID: 35917051 DOI: 10.1007/s10549-022-06659-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/13/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Although the incidence of breast cancer during pregnancy is increasing, little is known about short-term outcomes following breast cancer surgery during pregnancy. We aimed to compare the characteristics and outcomes of breast cancer surgery with and without pregnancy, and describe the obstetric outcomes following surgery. METHODS The data of 249,257 female patients aged < 60 years who underwent breast cancer surgery between July 2010 and March 2020 were analyzed using a nationwide Japanese database; we generated a 1:10 matched-pair cohort (260 and 2597 patients with and without pregnancy, respectively) matched according to age and treatment year. We conducted multivariable analyses to compare surgical procedures and outcomes, adjusting for potential confounders in the matched-pair cohort. Additionally, we described the obstetric outcomes of patients with pregnancy. RESULTS Patients with pregnancy were more likely to undergo total mastectomy [odds ratio: 1.48 (95% confidence interval: 1.13-1.94)] and axillary dissection [1.62 (1.17-2.24)], but less likely to undergo reconstruction [0.14 (0.07-0.31)], than patients without; however, postoperative complications, postoperative length of stay, and total hospitalization costs did not differ significantly with pregnancy. Additionally, some pregnant patients experienced premature delivery [n = 18 (6.9%)] and miscarriage [n = 4 (1.5%)], and 31 of 101 patients in the third trimester at breast cancer surgery underwent a cesarean section. CONCLUSION This study demonstrated significant differences regarding surgical procedures; however, there were no significant differences regarding surgical outcomes between patients who underwent breast cancer surgery with and without pregnancy. Obstetric outcomes following breast cancer surgery were also reported.
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32
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Auger N, Carrier FM, Arbour L, Ayoub A, Healy-Profitós J, Potter BJ. Association of first trimester anaesthesia with risk of congenital heart defects in offspring. Int J Epidemiol 2022; 51:737-746. [PMID: 33655302 DOI: 10.1093/ije/dyab019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A substantial number of pregnant women require anaesthesia for non-obstetric surgery, but the risk to fetal heart development is unknown. We assessed the relationship between first trimester anaesthesia and risk of congenital heart defects in offspring. METHODS We conducted a longitudinal cohort study of 2 095 300 pregnancies resulting in live births in hospitals of Quebec, Canada, between 1990 and 2016. We identified women who received general or local/regional anaesthesia in the first trimester, including anaesthesia between 3 and 8 weeks post-conception, the critical weeks of fetal cardiogenesis. The main outcome measures were critical and non-critical heart defects in offspring. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association of first trimester anaesthesia with congenital heart defects, using log-binomial regression models adjusted for maternal characteristics. RESULTS There were 107.3 congenital heart defects per 10 000 infants exposed to anaesthesia, compared with 87.2 per 10 000 unexposed infants. Anaesthesia between 3 and 8 weeks post-conception was associated with 1.50 times the risk of congenital heart defects (95% CI 1.11-2.03), compared with no anaesthesia. Anaesthesia between 5 and 6 weeks post-conception was associated with 1.84 times the risk (95% CI 1.10-3.08). Associations were driven mostly by general anaesthesia, which was associated with 2.49 times the risk between weeks 5 and 6 post-conception (95% CI 1.40-4.44). CONCLUSIONS General anaesthesia during critical periods of fetal heart development may increase the risk of congenital heart defects. Further research is needed to confirm that anaesthetic agents are cardiac teratogens.
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Affiliation(s)
- Nathalie Auger
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - François M Carrier
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Departments of Anaesthesiology and Medicine, Critical Care Division, University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Aimina Ayoub
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada., Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Jessica Healy-Profitós
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, QC, Canada
| | - Brian J Potter
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, QC, Canada
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33
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Thain S, McMicking J, de Naurois J, Nelson-Piercy C. Challenges in management of gastrointestinal cancers in pregnancies: A report of three cases. Obstet Med 2022; 15:141-145. [DOI: 10.1177/1753495x20987047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 11/15/2022] Open
Abstract
Gastrointestinal cancer occurs in approximately 1 in 13,000 pregnancies, making up 4% of malignancies detected in pregnancy. It is a complex and challenging condition to diagnose and manage and is often only detected in its more advanced stages. This is partly due to symptoms of gastrointestinal cancer being incorrectly attributed to physiological symptoms of pregnancy, as well as concerns about the safety of diagnostic investigations in pregnancy, both of which may delay diagnosis and lead to disease progression. Challenges in management also arise from under-treatment in pregnancy due to concerns about the impact of surgery or chemotherapy on the pregnancy. We present here three cases of gastrointestinal cancer diagnosed in pregnancy in our centre and discuss the challenges and pitfalls one may encounter in the diagnosis and management of gastrointestinal malignancies in pregnancy.
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Affiliation(s)
- Serene Thain
- Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Jess McMicking
- Department of Obstetrics and Gynaecology, Guy’s and St Thomas’ Hospital, London, UK
| | - Julien de Naurois
- Department of Oncology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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34
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Fu PH, Yu CH, Chen YC, Chu CC, Chen JY, Liang FW. Risk of adverse fetal outcomes following nonobstetric surgery during gestation: a nationwide population-based analysis. BMC Pregnancy Childbirth 2022; 22:406. [PMID: 35562679 PMCID: PMC9102935 DOI: 10.1186/s12884-022-04732-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Literature suggests that nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion, prematurity, and a higher cesarean section rate, but the direct impact on fetal outcomes is still unclear. In this study, we aimed to investigate whether nonobstetric surgery during pregnancy is associated with negative fetal outcomes by analysing a nation-wide database in Taiwan. METHODS This population-based retrospective observational case-control study was based on the linkage of Taiwan's National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database between 2004 and 2014. For every pregnancy with nonobstetric surgery during gestation, four controls were randomly matched according to maternal age and delivery year. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of adverse fetal outcomes with the non-surgery group as the reference. The primary outcomes involved stillbirth, prematurity, low birth weight, low Apgar scores, and neonatal and infant death. RESULTS Among 23,721 identified pregnancies, 4,747 underwent nonobstetric surgery. Pregnancies with nonobstetric surgery had significantly higher risks of prematurity (aOR: 1.46; 95% CI: 1.31-1.62), lower birth weight (aOR: 1.49; 95% CI: 1.33-1.67), Apgar scores < 7 (1 min, aOR: 1.58; 95% CI: 1.33-1.86; 5 min, aOR: 1.34; 95% CI: 1.03-1.74), neonatal death (aOR: 2.01; 95% CI: 1.18-3.42), and infant death (aOR: 1.69; 95% CI: 1.12-2.54) than those without nonobstetric surgery after adjustment for socioeconomic deprivation, hospital level, and other comorbidities. Surgery performed in the third trimester was associated with a significantly increased rate of prematurity (aOR: 1.38; 95% CI: 1.03-1.85), but lower rates of stillbirth (aOR: 0.1; 95% CI: 0.01-0.75) and Apgar score < 7 at the 5th minute (aOR: 0.2; 95% CI: 0.05-0.82), than surgery performed in the first trimester. CONCLUSIONS Pregnancies with nonobstetric surgery during gestation were associated with increased risks of prematurity, low birth weight, low Apgar scores, neonatal and infant death, longer admission, and higher medical expenses than those without surgery. Furthermore, surgery in the third trimester was associated with a higher rate of prematurity than surgery performed in the first trimester. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Pei-Han Fu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Hung Yu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yi-Chen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Challenging Obstetrical Management in Generalized Peritonitis during Pregnancy. Case Rep Obstet Gynecol 2022; 2022:1249676. [PMID: 35495091 PMCID: PMC9050313 DOI: 10.1155/2022/1249676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Acute abdomen in pregnancy represents a diagnostic and therapeutic challenge, despite the current advances in modern medicine, since the typical symptoms and altered laboratory parameters mimic normal pregnancy. Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy, with an incidence of 1 per 500-2000 pregnancies. Delayed diagnosis and reluctance to operate on a pregnant woman predispose to adverse maternal and fetal outcomes. The elective termination of pregnancy or interventions to prolong it in the presence of appendicitis is controversial. We present a case of a 38-year-old Caucasian woman, G2P0, admitted to the Obstetric Emergency Department at 13 4/7 weeks of gestation with a primary complaint of severe nausea and vomiting associated with progressive diffuse abdominal pain which had started 7 days before. After the difficulty of inherent differential diagnosis, she was diagnosed with generalized peritonitis due to acute perforated appendicitis. Prompt exploratory laparotomy with appendectomy and drainage of multiple abscesses were performed. Conservative obstetrical management was assumed, with subsequent periodic monitoring of the fetal focus. Due to abdominal compartment syndrome, the abdomen was left open for 4 days. After 7 days in the intensive care unit, recovery was favorable, pregnancy remained uneventful, and a healthy full-term baby was born 27 weeks later. This case represents a successful example of how the cooperation of the obstetrics and general surgery teams and the decision of conservative obstetrical management in the surgical environment contributed to optimizing maternal health, achieving the best obstetrical outcome.
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36
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Roberti R, Rocca M, Iannone LF, Gasparini S, Pascarella A, Neri S, Cianci V, Bilo L, Russo E, Quaresima P, Aguglia U, Di Carlo C, Ferlazzo E. Status epilepticus in pregnancy: a literature review and a protocol proposal. Expert Rev Neurother 2022; 22:301-312. [PMID: 35317697 DOI: 10.1080/14737175.2022.2057224] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date. AREAS COVERED In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach. EXPERT OPINION Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulfate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Morena Rocca
- Obstetrics and Gynecology Unit, "Pugliese-ciaccio" Hospital of Catanzaro, Catanzaro, Italy
| | | | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Leonilda Bilo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Paola Quaresima
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Costantino Di Carlo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Broadbent N, Selak V. Sounding a note of caution: first trimester anaesthesia and congenital heart defects. Int J Epidemiol 2022; 51:746-748. [PMID: 35381079 DOI: 10.1093/ije/dyac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/30/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicola Broadbent
- Department of Anaesthesia and Perioperative Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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38
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Bleeser T, Vally JC, Van de Velde M, Rex S, Devroe S. General anaesthesia for nonobstetric surgery during pregnancy: A narrative review. EUROPEAN JOURNAL OF ANAESTHESIOLOGY AND INTENSIVE CARE 2022; 1:e003. [PMID: 39916685 PMCID: PMC11783665 DOI: 10.1097/ea9.0000000000000003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/09/2025]
Abstract
Nonobstetric surgery may be required in up to 1% of pregnancies. Most common procedures are urgent abdominal surgeries requiring general anaesthesia. Maintaining normal maternal physiology during anaesthesia is vital. Left lateral tilt position prevents aortocaval compression and preserves normal venous return. Preparation for a difficult airway is required in all obstetric patients due to the known anatomical and physiological changes. Aspiration prophylaxis and a rapid sequence induction are traditionally recommended to avoid the (probably overestimated) risk of aspiration. Although the minimum alveolar concentration (MAC) of volatile anaesthetic agents is reduced by 30 to 40%, awareness occurs more frequently in the obstetric population. Maternal outcomes from surgery are comparable with those of nonpregnant women, but increased incidences of foetal loss, preterm delivery, low birth weight and caesarean section have been reported. Although animal studies have observed impaired foetal brain development after antenatal exposure to anaesthesia, the translational value of these studies remain controversial. Clinical evidence is nearly absent. Withholding urgent/essential procedures is certainly more threatening than proceeding with the surgery. To increase the safety of mother and foetus, nonurgent or nonessential procedures should be postponed until after delivery, and if procedures cannot wait, locoregional anaesthesia should be used if possible. Where general anaesthesia cannot be avoided, the duration of exposure should be kept to a minimum. This narrative review summarises the literature of the past 20 years concerning the anaesthetic management and outcomes of nonobstetric surgery under general anaesthesia during pregnancy.
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Affiliation(s)
- Tom Bleeser
- From the Department of Anaesthesiology, UZ Leuven (TB, JCV, MVDV, SR, SD) and Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (TB, MCV, SR, SD)
| | - Janine C Vally
- From the Department of Anaesthesiology, UZ Leuven (TB, JCV, MVDV, SR, SD) and Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (TB, MCV, SR, SD)
| | - Marc Van de Velde
- From the Department of Anaesthesiology, UZ Leuven (TB, JCV, MVDV, SR, SD) and Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (TB, MCV, SR, SD)
| | - Steffen Rex
- From the Department of Anaesthesiology, UZ Leuven (TB, JCV, MVDV, SR, SD) and Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (TB, MCV, SR, SD)
| | - Sarah Devroe
- From the Department of Anaesthesiology, UZ Leuven (TB, JCV, MVDV, SR, SD) and Department of Cardiovascular Sciences, Group Biomedical Sciences, KU Leuven, Leuven, Belgium (TB, MCV, SR, SD)
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Carter TJ, George C, Harwood C, Nathan P. Melanoma in pregnancy: Diagnosis and management in early-stage and advanced disease. Eur J Cancer 2022; 166:240-253. [PMID: 35325701 DOI: 10.1016/j.ejca.2022.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/30/2022] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
Approximately one-third of women diagnosed with melanoma are of child-bearing age. The annual incidence of melanoma has risen steadily over the last 40 years, resulting in increasing numbers of women diagnosed with melanoma both during pregnancy, and post-partum. To date, there are no formal guidelines on the management of pregnancy associated melanoma (PAM), both early stage and metastatic. This article reviews the existing literature and provides a framework for the investigation and multidisciplinary management of PAM.
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Affiliation(s)
- Thomas J Carter
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK
| | - Christina George
- Department of Dermatology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Catherine Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK
| | - Paul Nathan
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex, UK.
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Şahin B, Tinelli A, Augustin G. Are Cesarean Section and Appendectomy in Pregnancy and Puerperium Interrelated? A Cohort Study. Front Surg 2022; 9:819418. [PMID: 35252336 PMCID: PMC8891163 DOI: 10.3389/fsurg.2022.819418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction It is not known whether appendectomy for acute appendicitis (AA) increases the Cesarean section (CS) rate and whether CS increases the likelihood of AA and appendectomy in the early puerperium. In this study, delivery type and delivery outcomes and appendectomy during pregnancy and puerperium were analyzed. Methods This cross-sectional retrospective study was performed on 11,513 women, delivered during 2015–2020. Inclusion criteria were patients undergoing appendectomy for AA during pregnancy and the first 6 weeks after delivery. Evaluating parameters were age, parity, gestational week at birth, delivery type, and babies' birth weight. Results Thirty-two patients underwent appendectomy: 12 during pregnancy (2 in the first trimester, 6 in the second trimester, 4 in the third trimester) and 20 women during puerperium. 58.2% of pregnant women and 65% of puerperal women were submitted to CS. Discussion Half of the women who underwent appendectomy for AA during pregnancy may require urgent CS. The cause of acute abdomen in the postpartum period, especially in the first week, could be AA, especially in women delivered by CS.
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Affiliation(s)
- Banuhan Şahin
- Gynecology and Obstetrics Department, Amasya University Sabuncuoglu Serefeddin Training and Research Hospital, Amasya, Turkey
- *Correspondence: Banuhan Şahin
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinica SALentino), “Veris Delli Ponti Hospital”, Lecce, Italy
- Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Lecce, Italy
- Laboratory of Human Physiology, Faculty of Biological and Medical Physics, Phystech BioMed School, Moscow Institute of Physics and Technology (State University), Moscow Region, Russia
| | - Goran Augustin
- School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
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Solangon SA, Otify M, Gaughran J, Holland T, Ross J, Jurkovic D. The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies. Hum Reprod Open 2022; 2022:hoab046. [PMID: 35071800 PMCID: PMC8769667 DOI: 10.1093/hropen/hoab046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/19/2021] [Indexed: 12/29/2022] Open
Abstract
STUDY QUESTION What is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy? SUMMARY ANSWER In women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. WHAT IS KNOWN ALREADY Previous studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that. STUDY DESIGN, SIZE, DURATION A retrospective observational case–control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS All women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management. There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation. MAIN RESULTS AND THE ROLE OF CHANCE In the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2–30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7–32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2–24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44–2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9–90.2) and 38/48 (79%, 95% CI 65–89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4–87.2) live births in the control group (OR 0.87, 95% CI 0.39–1.94). LIMITATIONS, REASONS FOR CAUTION This study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies. STUDY FUNDING/COMPETING INTEREST(S) This work did not receive any funding. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER Research Registry: researchregistry6430.
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Affiliation(s)
- S A Solangon
- Gynaecology Diagnostics and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - M Otify
- Early Pregnancy and Gynaecology Unit, King’s College Hospital, London, UK
- Liverpool Women’s Hospital, Liverpool, UK
| | - J Gaughran
- Early Pregnancy and Gynaecology Unit, Guy’s and St Thomas’ Hospital, London, UK
| | - T Holland
- Early Pregnancy and Gynaecology Unit, Guy’s and St Thomas’ Hospital, London, UK
| | - J Ross
- Early Pregnancy and Gynaecology Unit, King’s College Hospital, London, UK
| | - D Jurkovic
- Gynaecology Diagnostics and Outpatient Treatment Unit, University College London Hospital, London, UK
- Institute for Women’s Health, University College London, London, UK
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Balikoglu M, Bayraktar B, Özsoy Ç, Kanmaz A, Özeren M. Comparison of the conservative approach with ureteral stent implantation in treating hydronephrosis during pregnancy. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2022. [DOI: 10.4103/injms.injms_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bradford V, Gaiser R. Preservation of Fetal Viability During Noncardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Laparoscopic treatment for appendicitis during pregnancy: Retrospective cohort study. Ann Med Surg (Lond) 2021; 68:102668. [PMID: 34408866 PMCID: PMC8361228 DOI: 10.1016/j.amsu.2021.102668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background Acute appendicitis is the most frequent non-obstetric surgical emergency during pregnancy. The benefits of laparoscopy during pregnancy are well known, but complications can occur, and these can affect both the mother and/or the foetus.We present results of laparoscopic surgical treatment of acute appendicitis in pregnant women, analysing the occurrence of adverse postoperative, obstetric and foetal outcomes and reviewing literature. Materials and methods Retrospective observational study on pregnant women with a preoperative diagnosis of acute appendicitis. Results n = 63, mean age 28.4 years, average gestational age of 17.7 weeks (3-30 weeks). 6.4 % exploratory laparoscopies, 92 % laparoscopic appendectomies and one right colectomy were performed. Conversion rate was 3.2 %. When symptoms begun within 48 hours prior to surgery, a perforated appendicitis was found in 11 %; whereas when the time from symptom onset to surgery was greater than or equal to 48 hours, it was evident in 31 % of the cases (p 0.008). The only independent variable associated with the presence of postoperative complications was symptom duration prior to surgery greater than or equal to 48 hours (OR 4.8; 95 % CI 1.1-16.2; p 0.04). Seven minor and 2 mayor postoperative complications were observed. Patients with complications spent, on average, twice as many days hospitalized (p < 0.001); and had 8 times more risk of preterm delivery (p 0.03). Obstetric complications were more frequent in pregnant women operated during the first trimester. Foetal mortality was 1.6 %. Conclusion Surgical morbidity of acute appendicitis in pregnant women is linked to the delay in the diagnosis and treatment of the inflammatory condition. Laparoscopic appendectomy during pregnancy is not exempt from postoperative, obstetric and foetal complications. It is necessary to standardize the definitions of "complication" in order to collate reliably the outcomes presented in the literature.
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Abstract
A surgical disease occurring during pregnancy can present a diagnostic dilemma due to the desire to make a timely and accurate diagnosis within the constraints of limiting radiation exposure to the fetus. However, required diagnostic imaging should be pursued when indicated and attempts made to minimize the radiation dose by utilizing abdominal shielding and low-dose protocols when feasible. When surgery is indicated due to disease processes, treatment should not be altered or delayed due to pregnancy as the evidence for adverse pregnancy outcomes including early pregnancy loss and preterm delivery are overall of low quality due to substantial confounding by the disease process itself.
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Abstract
Nonobstetric surgery during pregnancy occurs in 1% to 2% of pregnant women. Physiologic changes during pregnancy may have an impact when anesthesia is needed. Anesthetic agents commonly used during pregnancy are not associated with teratogenic effects in clinical doses. Surgery-related risks of miscarriage and prematurity need to be elucidated with well-designed studies. Recommended practices include individualized use of intraoperative fetal monitoring and multidisciplinary planning to address the timing and type of surgery, anesthetic technique, pain management, and thromboprophylaxis. Emergency procedures should be performed immediately and elective surgery should be deferred during pregnancy.
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Racial Disparities in the Risk of Complications After Nonobstetric Surgery in Pregnancy. Obstet Gynecol 2021; 138:236-245. [PMID: 34237757 DOI: 10.1097/aog.0000000000004454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine whether there are racial and ethnic differences in postoperative complications after nonobstetric surgery during pregnancy in the United States. METHODS We conducted a secondary analysis of the prospective ACS NSQIP (American College of Surgeons National Surgical Quality Improvement) program from 2005 to 2012. We assessed pregnant women 18-50 years without prior surgery in the preceding 30 days who underwent a nonobstetric surgery. Race and ethnicity were categorized as non-Hispanic Black, Hispanic, and non-Hispanic White (reference). The primary outcome was a composite of 30-day major postoperative complications inclusive of cardiovascular, pulmonary, and infectious complications, reoperation, unplanned readmission, blood transfusion, and death. We used modified Poisson regression to estimate the relative risk of complications. RESULTS Among 3,093 pregnant women, 18% were non-Hispanic Black, 20% Hispanic, and 62% non-Hispanic White. The most common surgeries were appendectomy (36%) and cholecystectomy (19%). Black women (18%) were more likely to be assigned American Society of Anesthesiologists (ASA) physical status class III or higher than their White (12%) or Hispanic (9%) peers. Non-Hispanic Black pregnant women had a higher risk of 30-day major postoperative complications compared with their White peers (9% vs 6%; adjusted relative risk [aRR] 1.41, 95% CI 1.11-1.99). This difference persisted when limiting the analysis to apparently healthy women (ASA class I or II) (7% vs 4%; aRR 1.64, 95% CI 1.08-2.50), those who underwent appendectomy (10% vs 3%; aRR 2.36, 95% CI 1.13-4.96), and when appendectomy and cholecystectomy were performed by laparoscopy (7% vs 3%; aRR 2.62, 95% CI 1.22-5.58). Hispanic pregnant women were not at an increased risk of complications compared with non-Hispanic pregnant White women. CONCLUSIONS Pregnant non-Hispanic Black women were at higher risk of major postoperative complications after nonobstetric surgery compared with their White counterparts.
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Meyer R, Meller N, Komem DA, Tsur A, Cohen SB, Mashiach R, Levin G. Pregnancy outcomes following laparoscopy for suspected adnexal torsion during pregnancy. J Matern Fetal Neonatal Med 2021; 35:6396-6402. [PMID: 34229536 DOI: 10.1080/14767058.2021.1914574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate pregnancy outcomes of women with surgically confirmed adnexal torsion (AT) as compared to those in whom AT was ruled out. METHODS A retrospective cohort study in a tertiary medical center. All pregnant women who underwent diagnostic laparoscopy due to suspected AT between 3/2011 and 4/2020 were included. We compared maternal, delivery and neonatal outcomes of both groups. We further compared women with confirmed AT to a control group of women who did not undergo laparoscopy during pregnancy. RESULTS During the study period, 112 women met the inclusion criteria. AT was confirmed in 93 cases (83.0%). Baseline characteristics did not differ between groups, excluding the rate of previous AT [5.4% in the torsion vs. 26.3% in the no-torsion group, odds ratio (OR) 0.15, 95% confidence interval (CI) 0.04-0.62, p = .004], and nulliparity rate (57.0% in the torsion vs. 31.6% in the no-torsion group, OR 2.41, 95%CI 1.004-8.21, p = .043). Pregnancies conceived by assisted reproductive technology were more common in the AT group compared to the no-AT group (46.2% vs. 10.5%, OR 7.21, 95%CI 1.59-33.45, p = .002). Miscarriage and stillbirth rates, gestational age at delivery, delivery characteristics and neonatal outcomes were favorable and did not differ between groups. Outcomes of pregnancies with confirmed AT did not differ from a control group of women who did not undergo laparoscopy during pregnancy. CONCLUSION Pregnancy outcomes among women who underwent laparoscopy for a suspected AT during pregnancy were reassuring, irrespective of the surgical findings and gestational week. Outcomes did not differ when compared to pregnant women who did not undergo laparoscopy. SYNOPSIS Maternal, fetal and neonatal outcomes among women who underwent laparoscopy for suspected adnexal torsion during pregnancy are reassuring, irrespective of the surgical findings and gestational week.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Meller
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daphna Amitai Komem
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomo B Cohen
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Mashiach
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel.,Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Levin
- Faculty of medicine, Hebrew University of Jerusalem, Israel; Department of Gynecologic Oncology, Hadassah Medical Center, Jerusalem, Israel
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Li RSO, Maglangit SACA, Cartagena-Lim JT, Dofitas RB. Case of a huge recurrent retroperitoneal liposarcoma diagnosed in the second trimester of pregnancy. BMJ Case Rep 2021; 14:14/7/e243639. [PMID: 34226256 DOI: 10.1136/bcr-2021-243639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We document a case of a 24-year-old gravida 2, para 1 (1001), on her second trimester, who was referred to the surgical oncology service for a palpable right hemiabdominal mass. She previously underwent wide excision of a retroperitoneal atypical lipomatous tumour 2 years ago. Her current case was successfully managed by a multidisciplinary team of doctors from the preoperative phase, the actual surgery up to the adjuvant treatment. She had a two-staged surgery: an elective lower-segment caesarean section at 34 weeks age of gestation for which she delivered a healthy baby girl and, 2 weeks after, she had excision of the huge retroperitoneal tumour recurrence. Histopathology revealed a 35 cm×25 cm×22 cm dedifferentiated liposarcoma, for which she was started on adjuvant systemic chemotherapy.
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Affiliation(s)
- Ryle Siegfrid O Li
- Division of Surgical Oncology, Head and Neck, Breast, Skin and Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sittie Aneza Camille A Maglangit
- Division of Surgical Oncology, Head and Neck, Breast, Skin and Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jemimah T Cartagena-Lim
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Rodney B Dofitas
- Division of Surgical Oncology, Head and Neck, Breast, Skin and Soft Tissue, and Esophagogastric Surgery, Department of Surgery, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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50
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Pancreatic Disorders of Pregnancy. Clin Obstet Gynecol 2021; 63:226-242. [PMID: 31789887 DOI: 10.1097/grf.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The pancreas is an organ with both exocrine and endocrine functions that has a vital role in both digestion as well as glucose metabolism. Although pancreatic dysfunction and disorders are rare in pregnancy, they are becoming increasingly more common. Recognition of these disorders and understanding how they can affect pregnancy is imperative to allow for proper management. We provide an overview of the most common pancreatic disorders that are seen in pregnancy.
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