Non-obstetric surgery during pregnancy: current perspectives and future directions

The 1-2% of pregnant women undergo surgery for pregnancy-unrelated conditions, such as appendicitis, cholecystitis, intestinal occlusion or adnexal mass complications. The early diagnosis and treatment of acute abdomen in pregnant woman are complicated by the physiological and anatomical changes of pregnancy, that make more problematic to recognize early signs of emergent conditions. Moreover, the fear of performing potentially dangerous diagnostic procedures contribute to further delay diagnosis and therapies. In case of acute non-obstetric surgical pathology, conservative management may adversely affect pregnancy outcomes, and surgical intervention should not be deferred only because of the gravid status or the gestational age. Non-obstetric surgery in pregnant patients has been proved to be safe if performed by a team composed by skilled surgeons and obstetricians, and both laparotomic and laparoscopic techniques can be applied if physiological and anatomical changes of pregnancy are considered, and appropriate adjustments are made by the anaesthesiologist. Nevertheless, in many hospital settings there is still a lack of knowledge, and many obstetricians and surgeons are reluctant to practice surgery in pregnant patients, especially laparoscopy. However, the recent available evidence supports non-obstetric surgery’s safety and efficacy, although more data are still needed to make strong recommendations and guidelines.