University of Oulu

Haataja A, Kokki H, Uimari O, Kokki M. Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review. Scandinavian Journal of Surgery. 2023;112(3):187-205. doi:10.1177/14574969231175569

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes : a systematic review

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Author: Haataja, Anna1; Kokki, Hannu2; Uimari, Outi1,3;
Organizations: 1PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
2School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
3Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
4Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: SAGE Publications, 2023
Publish Date: 2023-10-10


Background and objective: Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes.

Methods: A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates.

Results: We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0).

Conclusions: The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.

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Series: Scandinavian journal of surgery
ISSN: 1457-4969
ISSN-E: 1799-7267
ISSN-L: 1457-4969
Volume: 112
Issue: 3
Pages: 187 - 205
DOI: 10.1177/14574969231175569
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3123 Gynaecology and paediatrics
Copyright information: © The Finnish Surgical Society 2023. Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (