Date of Award

6-3-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Kurt Roberts

Abstract

The purpose of this study was to compare maternal and fetal outcomes between nonobstetric laparoscopy and laparotomy during pregnancy at Yale-New Haven Hospital. A retrospective chart review was conducted of all nonobstetric intraabdominal surgeries during pregnancy at Yale-New Haven Hospital between 1987 and 2007. Of 159 potential cases, 103 cases (57 laparoscopies, 46 laparotomies) fit the criteria for analysis. Data were collected for the maternal surgical admission, maternal delivery admission, and infant outcome for both groups, and were then analyzed using Statistical Analysis Software (SAS) Version 9.1. There was no difference in age or BMI between groups. Mean gestational age at time of surgery was higher among laparotomy patients (21.1 ± 7.9 weeks vs. 16.4 ± 7.3 weeks, p<0.05). There was no difference in the operative time between laparotomy and laparoscopy (79.8 ± 31.8 min vs. 86.1 ± 46.1 min, (p=0.43). The postoperative length of stay associated with laparotomy was double that associated with laparoscopy (4.5 ± 2.6 days vs. 2.2 ± 1.7 days, p<0.05). The postoperative complication rate was 47.4% after laparotomy and 17.4% after laparoscopy (p<0.05). There were no maternal deaths. Three fetal losses occurred but did not reach statistical significance. Mean gestational age at delivery, Apgar scores, and rate of low-birth-weight infants were comparable between groups. Our data demonstrate that nonobstetric laparoscopy during pregnancy maintains the advantages of minimally invasive surgery and has better maternal and fetal outcomes than nonobstetric laparotomy during pregnancy.

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