LAPAROSCOPY DURING PREGNANCY - A STUDY OF 5 FETAL-OUTCOME PARAMETERS WITH USE OF THE SWEDISH HEALTH REGISTRY

OBJECTIVE: Our purpose was to compare five fetal outcome variables bet ween laparoscopy and laparotomy performed during pregnancy with use of the Swedish Health Registries from 1973 to 1993. STUDY DESIGN: A data set was produced by linking computerized records from three Swedish He alth Registries. The dataset includes records for women who were deliv ered between 1973 and 1993 and had an operation within 1 year before g iving birth. The data were divided according to surgical procedure(s) and grouped according to diagnostic code(s). The following end points were studied in singleton births: birth weight, gestational duration, intrauterine growth restriction, congenital malformations, stillbirths , and neonatal deaths. in the analysis confounding by maternal age and parity, year of birth of the infant, maternal smoking, period of invo luntary infertility, and maternal cohabitation was taken into consider ation. A chi(2) analysis was used to compare proportions. Variables we re stratified with use of the Mantel-Haenszel procedure. Risk ratios w ere calculated for observed/expected ratios when outcomes for the tota l population were compared or as odds ratios when laparoscopy and lapa rotomy cohorts were compared. Expected values were calculated from the total population of women with singleton pregnancies. RESULTS: The st udy covered 2,015,000 deliveries in Sweden from 1973 to 1993. Data for this study were restricted to singleton pregnancies who had nonobstet ric operations between the fourth and twentieth weeks of pregnancy. To o few laparoscopic procedures were performed after 20 weeks to allow c omparison. A total of 2181 laparoscopies and 1522 laparotomies met cri teria for analysis. There were no significant differences between the two groups in any demographic variable. Pregnancies with operations we re compared with the total population for birth weight, gestational du ration, growth restriction, infant survival, and fetal malformations. On the basis of relative risks, there was an increased risk for infant s in both laparoscopy and laparotomy groups to weigh <2500 gm, to be d elivered before 37 weeks, and to have an increased incidence of growth restriction compared with the total population. There was no differen ce between laparoscopy and laparotomy in cumulative infant survival up to 1 year (odds ratio 0.85, 95% confidence interval 0.48 to 1.51). Th ere was no difference in the rate of fetal malformations between lapar oscopy (risk ratio 1.09, 95% confidence interval 0.90 to 1.11), laparo tomy (risk ratio 1.08, 95% confidence interval 0.85 to 1.11), and the total population. CONCLUSION: There is no difference in five fetal out come variables for patients undergoing laparoscopy versus laparotomy i n singleton pregnancies between 4 and 20 weeks of gestation.