Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
BMC Pregnancy Childbirth. 2022 May 13;22(1):406. doi: 10.1186/s12884-022-04732-w.
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.
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.
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 5 minute (aOR: 0.2; 95% CI: 0.05-0.82), than surgery performed in the first trimester.
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.
Not applicable.
文献表明，妊娠期间的非产科手术与自发性流产、早产和剖宫产率升高有关，但对胎儿结局的直接影响仍不清楚。本研究旨在通过分析台湾的全国性数据库，探讨妊娠期间非产科手术是否与不良胎儿结局有关。
这是一项基于人群的回顾性病例对照研究，基于台湾 2004 年至 2014 年的全民健康保险研究数据库、分娩报告数据库和母婴健康数据库进行。对于每一例妊娠期间接受非产科手术的孕妇，根据母亲年龄和分娩年份随机匹配 4 例对照。我们使用非手术组作为参考，估计不良胎儿结局的调整比值比（aOR）和 95%置信区间（CI）。主要结局包括死胎、早产、低出生体重、低 Apgar 评分、新生儿和婴儿死亡。
在 23721 例确定的妊娠中，有 4747 例接受了非产科手术。接受非产科手术的妊娠早产风险显著升高（aOR：1.46；95%CI：1.31-1.62），出生体重降低（aOR：1.49；95%CI：1.33-1.67），Apgar 评分<7（1 分钟，aOR：1.58；95%CI：1.33-1.86；5 分钟，aOR：1.34；95%CI：1.03-1.74），新生儿死亡（aOR：2.01；95%CI：1.18-3.42）和婴儿死亡（aOR：1.69；95%CI：1.12-2.54）高于未接受非产科手术的孕妇。与孕早期手术相比，孕晚期手术与早产率显著升高（aOR：1.38；95%CI：1.03-1.85）相关，而与死胎率（aOR：0.1；95%CI：0.01-0.75）和 Apgar 评分<7（5 分钟，aOR：0.2；95%CI：0.05-0.82）降低相关。
与未接受手术的孕妇相比，妊娠期间接受非产科手术的孕妇早产、低出生体重、低 Apgar 评分、新生儿和婴儿死亡、住院时间延长和医疗费用增加的风险更高。此外，与孕早期手术相比，孕晚期手术与更高的早产率相关。
不适用。
