Small Bowel Obstruction in Pregnancy

INTRODUCTION: The objective of this study was to review pregnancy outcomes and management options in pregnant women presenting with small bowel obstruction (SBO). METHODS: We conducted a systematic review of all studies describing SBO in pregnant women from 2006. Four bibliographic databases were searched using appropriate MeSH terms and keywords. Two reviewers independently screened articles and extracted data from eligible studies. Outcomes were described as proportions. RESULTS: We identified 3656 studies and included 78 describing 92 pregnancies. Most presented in the third (60%) or second (37%) trimesters. The commonest risk-factor was previous abdominal surgery (49%), presenting symptoms were abdominal pain (88%) and vomiting (67%) and examination findings were tenderness (49%) and distension (28%). Abnormal laboratory parameters were seen only in 26%. Diagnosis was confirmed on ultrasound (49%), computerized tomography (39%), X-ray (15%) or magnetic resonance imaging (14%). Conservative management was only successful in 4%, and laparoscopic surgery was only performed in 7%. The commonest aetiologies were adhesions (30%), internal hernias (25%) and volvulus (24%) and the commonest site was the ileum (37%). Maternal complications included death (4%), bowel perforation (14%), hypovolemic shock (12%) and sepsis (8%), while perinatal complications included prematurity (45%), low birthweight (11), stillbirths (9%) and neonatal death (4%). Almost 50% of the deliveries were by caesarean, to facilitate simultaneous surgical intervention for SBO, 88% of which were performed preterm. CONCLUSION: SBO is associated with high rates of adverse pregnancy outcomes, caesarean deliveries and iatrogenic prematurity. An algorithm for prompt diagnosis and management is needed to improve maternal and perinatal outcomes.