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Laparoscopy during pregnancy: A study of five fetal outcome parameters with use of the Swedish Health Registry

      Abstract

      Objective: Our purpose was to compare five fetal outcome variables between laparoscopy and laparotomy performed during pregnancy with use of the Swedish Health Registries from 1973 to 1993. Study design: A dataset was produced by linking computerized records from three Swedish Health Registries. The dataset includes records for women who were delivered between 1973 and 1993 and had an operation within 1 year before giving birth. The data were divided according to surgical procedure(s) and grouped according to diagnostic code(s). The following end points were studied in singleton births: birth weight, gestational duration, intrauterine growth restriction, congenital malformations, stillbirths, and neonatal deaths. In the analysis confounding by maternal age and parity, year of birth of the infant, maternal smoking, period of involuntary infertility, and maternal cohabitation was taken into consideration. A χ2 analysis was used to compare proportions. Variables were stratified with use of the Mantel-Haenszel procedure. Risk ratios were calculated for observed/expected ratios when outcomes for the total population were compared or as odds ratios when laparoscopy and laparotomy cohorts were compared. Expected values were calculated from the total population of women with singleton pregnancies. Results: The study covered 2,015,000 deliveries in Sweden from 1973 to 1993. Data for this study were restricted to singleton pregnancies who had nonobstetric operations between the fourth and twentieth weeks of pregnancy. Too few laparoscopic procedures were performed after 20 weeks to allow comparison. A total of 2181 laparoscopies and 1522 laparotomies met criteria for analysis. There were no significant differences between the two groups in any demographic variable. Pregnancies with operations were compared with the total population for birth weight, gestational duration, growth restriction, infant survival, and fetal malformations. On the basis of relative risks, there was an increased risk for infants in both laparoscopy and laparotomy groups to weigh <2500 gm, to be delivered before 37 weeks, and to have an increased incidence of growth restriction compared with the total population. There was no difference between laparoscopy and laparotomy in cumulative infant survival up to 1 year (odds ratio 0.85, 95% confidence interval 0.48 to 1.51). There was no difference in the rate of fetal malformations between laparoscopy (risk ratio 1.09, 95% confidence interval 0.90 to 1.11), laparotomy (risk ratio 1.08, 95% confidence interval 0.85 to 1.11), and the total population. Conclusion: There is no difference in five fetal outcome variables for patients undergoing laparoscopy versus laparotomy in singleton pregnancies between 4 and 20 weeks of gestation.

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      References

        • Soper NJ
        • Hunter JG
        • Petrie RH.
        Laparoscopic cholecystectomy during pregnancy.
        Surg Endosc. 1992; 6: 115-117
        • Pucci RO
        • Seed RW.
        Case report of laparoscopic cholecystectomy in the third trimester of pregnancy.
        Am J Obstet Gynecol. 1991; 78: 401-402
        • Schreiber JH.
        Laparoscopic appendectomy in pregnancy.
        Surg Endosc. 1990; 4: 100-102
        • Lang PF
        • Tamussino K
        • Winter R.
        Laparoscopic management of adnexal torsion during the second trimester [letter].
        Int J Gynecol Obstet. 1992; 37: 37
        • Shalev E
        • Rahav D
        • Romano S.
        Laparoscopic relief of adnexal torsion in early pregnancy: case reports.
        Br J Obstet Gynaecol. 1990; 97: 853-854
        • Nezhat F
        • Nezhat C
        • Silfen SL
        • Fehnal SH.
        Laparoscopic ovarian cystectomy during pregnancy.
        J Laparoendosc Surg. 1991; 1: 161-164
        • Cristalli B
        • Cayol A
        • Izard V
        • Levardon M.
        Benefit of operative laparoscopy for ovarian tumors suspected of benignity.
        J Laparoendosc Surg. 1992; 2: 69-73
        • Cnattingius S
        • Ericson A
        • Gunnarskog J
        • Källén B
        A quality study of a medical birth registry.
        Scand J Soc Med. 1990; 18: 143-148
        • Källén B
        Search for teratogenic risks with the aid of malformation registries.
        Teratology. 1987; 35: 47-52
        • Mazze RI
        • Källén B
        Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases.
        Am J Obstet Gynecol. 1989; 161: 1178-1185
        • Källén B
        A birth weight for gestational age standard based on data in the Swedish Medical Birth Registry, 1985-1989.
        Eur J Epidemiol. 1995; 11: 601-606
        • Duncan PG
        • Pope WDB
        • Cohen M
        • Greer N.
        The safety of anesthesia and surgery during pregnancy.
        Anesthesiology. 1986; 64: 790-794
        • Reedy MR
        • Galan HL
        • Richards WE
        • Preece CK
        • Wetter PA
        • Kuehl TJ.
        Laparoscopy during pregnancy: a study of laparoendoscopic surgeons.
        J Reprod Med. 1997; 42: 33-38