Augustin Goran, Krstulović Jure, Tavra Ante, Hrgović Zrinka
Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia.
Department of Surgery, University Hospital of Split, Split 21000, Croatia.
World J Gastrointest Surg. 2025 Apr 27;17(4):101682. doi: 10.4240/wjgs.v17.i4.101682.
Peptic ulcer disease (PUD) during pregnancy is extremely rare. Perforated peptic ulcer (PPU) during pregnancy has high maternal and fetal mortality. Symptoms attributed to pregnancy and other diagnoses make the diagnosis of preoperative PPU during pregnancy and puerperium challenging.
To identify predictive factors for early diagnosis and treatment, and the association between the diagnosis and maternal/neonatal outcomes.
We searched PubMed, PubMed Central, and Google Scholar. Articles were analyzed following preferred reporting items for systematic reviews and meta-analysis. The search items included: 'ulcer', 'PUD', 'pregnancy', 'puerperium', 'postpartum', 'gravid', 'labor', 'perforated ulcer', 'stomach ulcer', 'duodenal ulcer', 'peptic ulcer'. Additional studies were extracted by reviewing reference lists of retrieved studies. We included all available full-text cases and case series. Demographic, clinical, obstetric, diagnostic and treatment parameters, and outcomes were collected.
Forty-three cases were collected. The mean maternal age was 30.9 years; 36.6% were multiparous, and 63.4% were nulliparous or primiparous, with multiparas being older than primiparas. Peptic ulcer perforated in 44.2% of postpartum and 55.8% of antepartum patients. Antepartum PPU incidence increased with advancing gestation 2.3% in the first, 7% in the second, and 46.5% in the third trimester. The most common clinical findings were abdominal tenderness (72.1%), rigidity (34.9%), and distension (48.8%). Duodenal ulcer predominated (76.7%). In 79.5%, the time from delivery to surgery or vice versa was > 24 hours. The maternal mortality during the third trimester and postpartum was 10% and 31.6%, respectively. The trimester of presentation did not influence maternal mortality. The fetal mortality was 34.8%, with all deaths in gestational weeks 24-32.
Almost all patients with PPU in pregnancy or puerperium presented during the third trimester or the first 8 days postpartum. Early intervention reduced fetal mortality but without influence on maternal mortality. Maternal mortality did not depend on the use of X-ray imaging, perforation location, delivery type, trimester of presentation, and maternal age. Explorative laparoscopy was never performed during pregnancy, only postpartum.
妊娠期消化性溃疡病（PUD）极为罕见。妊娠期消化性溃疡穿孔（PPU）具有较高的母婴死亡率。妊娠和产褥期因妊娠相关症状及其他诊断导致术前PPU的诊断具有挑战性。
确定早期诊断和治疗的预测因素，以及诊断与母婴结局之间的关联。
我们检索了PubMed、PubMed Central和谷歌学术。按照系统评价和荟萃分析的首选报告项目对文章进行分析。检索词包括：“溃疡”、“PUD”、“妊娠”、“产褥期”、“产后”、“孕期”、“分娩”、“溃疡穿孔”、“胃溃疡”、“十二指肠溃疡”、“消化性溃疡”。通过查阅检索到的研究的参考文献列表提取其他研究。我们纳入了所有可用的全文病例和病例系列。收集人口统计学、临床、产科、诊断和治疗参数以及结局。
共收集43例病例。产妇平均年龄为30.9岁；36.6%为经产妇，63.4%为未产妇或初产妇，经产妇年龄大于初产妇。44.2%的产后患者和55.8%的产前患者发生消化性溃疡穿孔。产前PPU发病率随孕周增加而升高，孕早期为2.3%，孕中期为7%，孕晚期为46.5%。最常见的临床表现为腹部压痛（72.仁%）、僵硬（34.9%）和腹胀（48.8%）。十二指肠溃疡占主导（76.7%）。79.5%的患者从分娩到手术或反之的时间>24小时。孕晚期和产后的产妇死亡率分别为10%和31.6%。发病孕周不影响产妇死亡率。胎儿死亡率为34.8%，所有死亡均发生在孕24 - 32周。
几乎所有妊娠期或产褥期PPU患者均在孕晚期或产后前8天就诊。早期干预可降低胎儿死亡率，但对产妇死亡率无影响。产妇死亡率不取决于是否使用X线成像、穿孔部位、分娩方式、发病孕周和产妇年龄。妊娠期从未进行过探索性腹腔镜检查，仅在产后进行。
