Factors contributing to pregnancy loss after appendectomy, cholecystectomy identified

Last Updated: 2017-01-26

By Marilynn Larkin

NEW YORK (Reuters Health) - Cervical incompetence, preterm labor, vaginitis or vulvovaginitis and sepsis increase the risk of adverse outcomes after appendectomy or cholecystectomy during pregnancy, researchers say.

Dr. Adam Sachs of the University of Connecticut School of Medicine in Farmington told Reuters Health that when women undergo these procedures during pregnancy "they are obviously concerned about the well being of their fetus."

"Unfortunately, the majority of the data available to counsel pregnant women is outdated and medical practice has significantly changed since their publication," he said by email. "In our study, we identify risk factors for adverse pregnancy outcomes after appendectomy and cholecystectomy and develop a scoring system to assist practitioners in their discussions with these patients."

As reported in JAMA Surgery, online January 18, Dr. Sachs and colleagues analyzed medical records of 19,926 women (mean age, 26) who had an appendectomy or cholecystectomy during pregnancy from 2003 to 2012.

Of those, 953 (4.8%) had 1,081 adverse obstetrical events, the three most frequent of which were preterm delivery (35.4%), preterm labor without preterm delivery (26.4%) and miscarriage (25.7%).

Dr. Sachs said, "Instead of disease severity and surgical variables, pregnancy-related risk factors were most important for determining a pregnant woman's risk of a negative pregnancy outcome."

Risk factors associated most strongly with an adverse outcome included cervical incompetence (adjusted odds ratio, 24.29), preterm labor during current pregnancy (aOR, 18.34), vaginitis or vulvovaginitis (aOR, 5.17) and sepsis (aOR, 3.39).

The team developed a scoring system based on the risk factors: cervical incompetence, 16 points; preterm labor during current pregnancy, 15; vaginitis or vulvovaginitis, 8; multiple gestations, 6; sepsis, 6; open surgery, 5; peritonitis, 5; drug abuse or dependence, 3; nonwhite race/ethnicity, 2; and Medicaid coverage, 1.

They categorized participants into three risk groups based on the sum of the points, corresponding to predicted probabilities of adverse outcomes: 74.3% were in the low-risk group (</=4 points), 20.5% were in the intermediate-risk group (5-8 points), and 5.2% were in the high-risk group (>/=9 points).

Predicted probabilities of adverse obstetrical outcomes in the low-, intermediate-, and high-risk groups were 2.5%, 8.2%, and 21.8%, respectively.

Dr. Sachs concluded, "Future research should focus on confirming these risk factors and creating interventions to prevent, or at least lower, the risk of miscarriage or preterm delivery for pregnant women with modifiable risk factors."

Dr. Joe Hines of the University of California, Los Angeles, told Reuters Health by email, "Emergency operations in pregnant patients can be complicated by pregnancy loss. High quality data helping to inform patients and physicians about this risk has not been available, but this study provides a scoring system that can help."

Dr. Hines concluded, "Doctors should address vaginitis, vulvovaginitis, or cervical incompetence in pregnant patients requiring surgery in order to reduce the risk of perioperative fetal loss."

SOURCE: http://bit.ly/2kx9p4Q and http://bit.ly/2kx8Qbp

JAMA Surg 2017.