EGS in Pregnancy
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- Trends in appendicitis among pregnant women, risk for cardiac arrest, and maternal-fetal mortality.
- Dongarwar D, Taylor J, Ajewole V, Anene N, Omoyele O, Ogba C, Oluwatoba A, Giger D, Thuy A, Argueta E, Naik E, Salemi J, Spooner K, Olaleye O, Salihu H.
- World J Surg. 2020 Dec;44(12):3999-4005.
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Rationale for inclusion: Large, retrospective review of appendicitis in pregnancy using NIS data, identifying the increased risk of both fetal loss (2x increase) and inpatient maternal mortality (5x increase) compared to pregnant mothers without appendicitis. Increased fetal loss and mortality associated with underlying pre-existing conditions. This highlights the potential morbidity and mortality of appendicitis in pregnancy.
CAVEAT: No data regarding operative vs non-operative outcomes provided.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Appendicitis in pregnancy: A post-hoc analysis of an EAST multicenter study.
- Vasileiou G, Eid AI, Qian S, Pust G, Rattan R, Namias N, Larentzakis A, Kaafarani H, Yeh D.
- Surg Infect (Larchmt). 2020 Apr;21(3):205-211.
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Rationale for inclusion: Post-hoc analysis of EAST multicenter observational study identifying the increased likelihood of pregnant women to develop complicated appendicitis, be treated with abx rather than surgery, and to undergo negative appendectomy (3x higher than non-pregnant patients). The latter is likely due to the increased complexity of diagnosis and risk of delayed intervention in gravid patients. Overall outcomes were similar to non-pregnant controls.
Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Abdominal wall hernia and pregnancy: A systematic review.
- Jensen K, Henriksen N, Jorgensen L.
- Hernia. 2015 Oct;19(5):689-96.
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Rationale for inclusion: Review of 31 manuscripts, reviewing outcomes of hernia repair in fertile women. While no major complications were reported following hernia repair before or during pregnancy, some patients developed significant pain related to repair (both primary suture and mesh repair) during the late stages of subsequent pregnancy. Additionally, incarcerated hernia repair during pregnancy and hernia repair at time of cesarean section appear safe.
CAVEAT: Limited largely to individual case reports and small case series.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Effect of pregnancy on adverse outcomes after general surgery.
- Moore H, Juarez-Colunga E, Bronsert M, Hammermeister K, Henderson W, Moore E, Meguid R.
- JAMA Surg. 2015 Jul;150(7):637-43.
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Rationale for inclusion: Retrospective cohort study comparing 30-day postoperative surgical outcomes of pregnant vs non-pregnant women undergoing nonobstetric operations by general surgeons, demonstrating no increase in morbidity or mortality. This highlights the relative safety of emergency and nonemergency general surgical procedures in pregnant women.
CAVEAT: No discussion of fetal complications, which must be considered in elective surgical situations.Citations - To review the number of citations for this landmark paper, visit Google Scholar.
- Management of pancreatitis complicating pregnancy.
- Swisher S, Hunt K, Schmit P, Hiyama D, Bennion R, Thompson J.
- Am Surg. 1994 Oct;60(10):759-62.
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Rationale for inclusion: Retrospective review of pancreatitis in pregnancy, identifying a significant GSP recurrence rate in patients prior to delivery, requiring additional hospitalization. No readmission or fetal or maternal morbidity occurred as a result of cholecystectomy performed during the first or second trimester, suggesting a benefit of intervention when premature labor and risk of anesthesia are lowest.
CAVEAT: 30 patient case series.Citations - To review the number of citations for this landmark paper, visit Google Scholar.