Updates on Obstetric Surgical Procedures and Effect of Gynecological Surgery on Pregnancy Outcome

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (15 May 2023) | Viewed by 7627

Special Issue Editor


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Guest Editor
Department of Obstetrics and Gynecology, Ospedale dei Bambini "Vittore Buzzi", University of Milano, Milan, Italy
Interests: preterm parturition; preeclampsia; recurrent pregnancy loss; intrauterine growth restriction; fetal demise; premature rupture of membranes

Special Issue Information

Dear Colleagues,

Surgical procedures during pregnancy are not common; however, they are sometimes necessary, with reported incidence of 0.75%. Almost every type of surgery has been performed during pregnancy, though most of the data come from experience with appendectomy which is considered to be safe in all trimesters. In other reports, laparoscopic approaches for different indications as well as other surgical procedures during pregnancy are considered safe in experienced hands. 

A multidisciplinary team including obstetricians, surgeons, anesthesiologists and neonatologists should be involved in the management of patients requiring surgical procedures during pregnancy. Modifications to anesthetic and surgical techniques may be required due to the anatomical and physiological changes related to pregnancy, as well as due to fetal concerns. 

The choice of the surgical technique depends on the patient’s medical condition, surgical needs and goals, gestational age and the surgeon’s skills. 

Postoperative complications are considered to be relatively unusual, and occur in a similar frequency as in the non-pregnant population with the same diagnoses. The patient’s underlying condition appears to be the most important factor for the obstetrical outcome, not the type of surgical procedure that is performed. 

Another important aspect to consider is the effect on pregnancy outcome of gynecological surgery performed outside pregnancy. 

The purpose of this Special Issue is to analyze these relevant aspects and provide evidence-based literature to be used in daily clinical practice.

Dr. Salvatore Andrea Mastrolia
Guest Editor

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Keywords

  • obstetric surgery
  • gynecological surgery
  • pregnancy outcome

Published Papers (5 papers)

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Editorial

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3 pages, 177 KiB  
Editorial
“To Do or Not to Do, That Is the Question”, Surgery and Pregnancy
by Salvatore Andrea Mastrolia
J. Clin. Med. 2022, 11(17), 5095; https://doi.org/10.3390/jcm11175095 - 30 Aug 2022
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Abstract
Whenever we associate the terms “pregnancy” and “surgery”, we tend to first think to cesarean sections [...] Full article

Research

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10 pages, 436 KiB  
Article
Effects of Amnioreduction before Physical Examination-Indicated Cerclage on Pregnancy Outcomes: A Propensity Score Matched Study
by Subeen Hong, Hyun Sun Ko, Seonok Kim, Yun Sung Jo and In Yang Park
J. Clin. Med. 2023, 12(7), 2480; https://doi.org/10.3390/jcm12072480 - 24 Mar 2023
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Abstract
This study investigated the effects of amnioreduction before physical examination-indicated cerclage on pregnancy outcomes using a propensity score matching analysis. This multicenter retrospective cohort study included women who underwent cerclage operations due to painless cervical dilation in the second trimester (14–28 weeks). The [...] Read more.
This study investigated the effects of amnioreduction before physical examination-indicated cerclage on pregnancy outcomes using a propensity score matching analysis. This multicenter retrospective cohort study included women who underwent cerclage operations due to painless cervical dilation in the second trimester (14–28 weeks). The primary outcome was the time from operation until delivery. Secondary outcomes included preterm birth rate and neonatal outcomes. Primary and secondary outcomes were compared between those with amnioreduction and those without amnioreduction. Of 103 women, 31 received preoperative amnioreduction (amnioreduction group) and 72 women did not (no-amnioreduction group). Since there were differences in baseline characteristics and preoperative ultrasound findings between the two groups, we matched 25 women with amnioreduction and 25 women without amnioreduction using a propensity score. In the matched cohort, the amnioreduction group showed a shorter time from operation to delivery than the group without amnioreduction and the hazard ratio of amnioreduction was 2.5 (95% confidence interval; 1.4–4.7). In addition, the preterm birth rate before 28 weeks of gestation and the neonatal composite outcome were higher in the amnioreduction group than that in the group without amnioreduction. Amnioreduction before physical examination-indicated cerclage was associated with poor pregnancy and neonatal outcomes. Therefore, careful consideration is required when performing amnioreduction before cerclage operation. Full article
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11 pages, 2014 KiB  
Article
Effect of Two-Port Laparoscopic Surgery on Pregnancy Outcomes of Patients with Concurrent Adnexal Masses
by Ying-Xuan Li, Mu-En Ko, Ching Hsu, Kuan-Ju Huang, Bor-Ching Sheu and Wen-Chun Chang
J. Clin. Med. 2022, 11(16), 4697; https://doi.org/10.3390/jcm11164697 - 11 Aug 2022
Cited by 2 | Viewed by 1674
Abstract
Adnexal masses are common in pregnancy, with 2–10% of pregnancies presenting with an ovarian mass and approximately 1–6% of these masses being malignant. For suspected malignancy or masses with symptoms, surgery must be performed as early as possible. We retrospectively investigated the effect [...] Read more.
Adnexal masses are common in pregnancy, with 2–10% of pregnancies presenting with an ovarian mass and approximately 1–6% of these masses being malignant. For suspected malignancy or masses with symptoms, surgery must be performed as early as possible. We retrospectively investigated the effect of two-port laparoscopic surgery on the outcomes of patients with concurrent adnexal masses between 2012 and 2019 (including large mucinous tumor, large teratoma, serous borderline tumor, and heterotopic pregnancy). Laparoscopic right partial oophorectomy was performed for a 27 cm ovarian mucinous tumor at a gestational age (GA) of 21 weeks, laparoscopic right oophorocystectomy for an 18 cm teratoma at a GA of 10 weeks, and laparoscopic left salpingo-oophorectomy for a 7 cm serous borderline tumor at a GA of 7 weeks after ultrasonographic confirmation of an intrauterine gestational sac with a fetal heartbeat. Laparoscopic excision of a tubal pregnancy was performed in a heterotopic pregnancy at a GA of 12 weeks with massive internal bleeding. Laparoscopic surgery is easier and safe to perform during early pregnancy because a smaller uterus allows for superior visualization. All of these patients had optimal postoperative recovery and normal spontaneous delivery at term. We discussed several aspects of treatment and delivery, namely treatment option (expectant management or surgery), surgery timing (early or advanced pregnancy), surgery type (laparoscopy or laparotomy), and delivery route (normal spontaneous delivery or cesarean section), in patients with concurrent adnexal tumors and their effects on pregnancy outcomes. Full article
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6 pages, 196 KiB  
Article
Obstetric Outcomes after Perforation of Uterine Cavity
by Polina Schwarzman, Yael Baumfeld, Salvatore Andrea Mastrolia, Shimrit Yaniv-Salem, Elad Leron and Tali Silberstein
J. Clin. Med. 2022, 11(15), 4439; https://doi.org/10.3390/jcm11154439 - 30 Jul 2022
Cited by 4 | Viewed by 1342
Abstract
We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center [...] Read more.
We aimed to evaluate the pregnancy characteristics and obstetric outcomes in patients after perforation of the uterus. Study design: A retrospective cohort study was conducted and included all patients who were diagnosed with uterine perforation and treated in a tertiary referral medical center between the years 1996 and 2018. Up to two deliveries after perforations were investigated. Results: During the study period, 51 women were diagnosed with uterine perforation during gynecological procedures, including intrauterine device (IUD) insertion. The mean age of patients at the time of diagnosis was 27.9 (±4.7) years. The majority, 76.5% (n = 39), experienced perforation during IUD insertion, and 23.5% (n = 12) of the patients experienced perforation during surgical procedures. Most of the patients were multiparous or grand multiparous, 45.8. % (n = 22) and 39.6% (n = 19) respectively. Anteflexed uterus was found in 86.4% of the patients (n = 38). Five patients (9.8%) had pelvic abscesses after the IUD insertion. A total of 50 patients had 71 deliveries subsequent to uterine perforation. One patient experienced intrauterine fetal death due to fetal malformations. One patient experienced uterine rupture. No other major obstetric complications were noted. Conclusions: Uterine perforation may be associated with adverse obstetric outcomes. The possibility of uterine rupture must be considered while managing the deliveries of patients after uterine perforation. Moreover, a larger cohort and further studies are needed to establish an association between uterine perforation and adverse outcomes of the subsequent deliveries. Full article

Other

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8 pages, 1712 KiB  
Case Report
A Rare Case of Tricuspid Valve Libman–Sacks Endocarditis in a Pregnant Woman with Primary Antiphospholipid Syndrome
by Sonia Migliorini, Ciro Santoro, Alessandra Scatteia, Santo Dellegrottaglie, Antonella Tufano, Vittoria Cuomo, Emanuele Pilato, Giuseppe Comentale, Maria D’Armiento, Maurizio Guida and Laura Sarno
J. Clin. Med. 2022, 11(19), 5875; https://doi.org/10.3390/jcm11195875 - 05 Oct 2022
Cited by 3 | Viewed by 1990
Abstract
Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with [...] Read more.
Antiphospholipid Antibody Syndrome (APS) is a systemic autoimmune disease characterized by acquired hypercoagulability with the possible development of venous, arterial, and microvascular thrombosis. We report a rare case of Libman–Sacks tricuspid valve endocarditis in a 38-year-old pregnant woman at 15 weeks gestation with unknown primary antiphospholipid syndrome. During a routine cardiac examination and echocardiography performed for a previous episode of pleuropericarditis, a large, mobile mass with irregular edges was found at the level of the tricuspid valve. Three main differential diagnoses for intramyocardial mass were examined: tumor, infective endocarditis, and nonbacterial thrombotic endocarditis (NTBE). Cardiac magnetic resonance imaging (CMR) with contrast raised the suspicion of a thrombus. The woman was hospitalized urgently at the Cardiac Intensive Care Unit of the Federico II University Hospital, and anticoagulant and antiplatelet therapy were started. The thrombophilic screening performed and medical history confirmed the diagnosis of primary antibody syndrome (APS). A multidisciplinary consultation with obstetricians, cardiologists, anesthetists, and cardiac surgeons was required. The patient decided not to terminate the pregnancy despite the risk to her health and to undergo cardiac surgery during pregnancy. Histological examination confirmed the presence of nonbacterial thrombotic endocarditis. Weekly obstetric scans were performed after surgery to verify fetal well-being. An emergency cesarean section was performed at the 35th week of gestation due to repeated deceleration and abnormal short-term variability on c-CTG in a pregnancy complicated by fetal growth restriction and gestational hypertension. A newborn weighing 1290 g was born. She was hospitalized in Neonatal Intensive Care and discharged after two months; currently, she enjoys good health. The management of patients with antiphospholipid antibody syndrome has not yet been standardized, but there is a general consensus that patients who do not have thrombocytopenia, thromboembolic phenomena, or pregnancy should not undergo any treatment or should take only low doses of acetylsalicylic acid. In the presence of any of the above conditions, various treatment regimens have been used based on the severity and individuality of the case. Full article
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