To quantify the absolute risks of adverse fetal outcomes and maternal mortality following non-obstetric abdominopelvic surgery in pregnancy.
Surgery is often necessary in pregnancy, but absolute measures of risk required to guide perioperative management are lacking.
We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews from January 1, 2000, to December 9, 2020, for observational studies and randomized trials of pregnant patients undergoing non-obstetric 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.
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 (e.g. appendectomy, adnexal torsion) than for abdominal or non-urgent conditions (e.g. cholecystectomy, adnexal mass). Surgery in the second and third trimester 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 trimester (fetal loss 2.9%, preterm birth 5.6%).
Absolute risks of adverse fetal outcomes after non-obstetric abdominopelvic 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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