Perforated peptic ulcer in pregnancy and puerperium: A systematic review

Table 1 Baseline information, n (%)

Baseline information
Mean maternal age, years	30.9 (95%CI: 27.9-32.3)
Multiparous (n = 38)	15 (39.5)
Primiparous (n = 38)	17 (44.7)
Nulliparous (n = 38)	6 (15.8)
Antepartum ulcer perforations (n = 43)	24 (55.8)
Postpartum ulcer perforations (n = 43)	19 (44.2)
First-trimester presentation (n = 43)	1 (2.3)
Second-trimester presentation (n = 43)	3 (7)
Third-trimester presentation (n = 43)	20 (46.5)
Duodenal ulcers (n = 34)	26 (76.5)
Gastric ulcers (n = 34)	8 (23.5)

CI: Confidence interval.

Table 2 Clinical presentation of perforated peptic ulcer in pregnancy, n (%)

Group	Abdominal pain	Nausea/vomiting	Hematemesis	Diarrhea	Jaundice	Constipation
Antepartum (n = 19)	18 (94.7)	14 (73.7)	3 (15.8)	0 (0)	0 (0)	0 (0)
Postpartum (n = 24)	24 (100)	17 (70.8)	3 (12.5)	2 (8.3)	2 (8.3)	4 (16.7)

Table 3 Maternal medical history related to peptic ulcer, n (%)

Maternal medical history
Dyspepsia (n = 43)	12 (27.9)
History of ulcer (n = 43)	3 (7)
Eclampsia/preeclampsia (n = 43)	6 (14)
None (n = 43)	14 (32.6)
Unknown (n = 43)	8 (18.6)

Table 4 Clinical examination of perforated peptic ulcer in pregnancy, n (%)

Group	Abdominal tenderness	Abdominal rigidity	Abdominal distension	Absence of peristalsis
Antepartum (n = 19)	17 (89.5)	7 (36.8)	4 (21.1)	5 (26.3)
Postpartum (n = 24)	17 (70.8)	5 (20.8)	16 (66.7)	5 (20.8)

Table 5 Diagnostic imaging and examination, n (%)

Diagnostic
Plain abdominal X-ray (n = 43)	11 (25.6)
Positive X-ray findings (n = 11)	10 (90.9)
Abdominal ultrasound (n = 43)	10 (23.6)
Positive findings (n = 10)	8 (80)
Performed vaginal examination (n = 43)	13 (30.3)
Normal (n = 13)	12 (92.3)
Computed tomography (n = 43)	3 (7)

Table 6 Frequencies of surgical procedure

Surgical procedure	Frequency	Percent (%)
Primary closure	17	39.5
Graham’s patch	16	37.2
Primary closure with omentoplasty	3	7.0
Modified Graham’s patch	2	4.7
Partial gastric resection	2	4.7
No procedure	3	7.0

Table 7 Fetal death by gestational week at presentation

Gestational week at presentation	Number of fetal death outcomes out of total cases by week
15	0/1
20	0/1
24	1/1
28	2/2
31	3/3
32	2/3
34	0/2
35	0/1
36	0/3
38	0/2
39	0/2
41	0/1
43	0/1