Objectives To evaluate the absolute risks of adverse fetal outcomes and maternal mortality following non-obstetric abdominopelvic surgery in pregnancy. Methods We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews from January 1, 2000, for randomized trials and observational studies of pregnant patients (N>20) undergoing non-obstetric abdominopelvic surgery. We determined the pooled proportions of fetal loss, preterm birth, and maternal mortality using generalized linear mixed-effects models with a logit link, and assessed risk of bias using the Institute of Health Economics Quality Appraisal Checklist. Results We identified 85 observational studies (39 appendectomy, 27 adnexal, 13 mixed types, 6 cholecystectomy) including 43,261 pregnant patients undergoing non-obstetric abdominopelvic surgery. Pooled proportions of fetal loss, preterm birth, and maternal mortality were 2.6% (95% CI 1.5-4.4), 9.5% (95% CI 7.8-11.5), and 0.04% (95% CI 0.02-0.09) respectively. In subgroup analyses, the pooled proportion of fetal loss was higher for appendectomy (3.3%, 95% CI 2.2-4.9) and emergent surgery for ovarian torsion (5.6%, 95% CI 2.2-13.2) than for cholecystectomy (0.4%, 95% CI 0.1-3.1) and elective surgery for ovarian masses (1.0%, 95% CI 0.4-2.6). Similar patterns were observed for preterm birth. Studies of first and second trimester patients had higher rates of fetal loss (1.3-2.7%) and lower rates of preterm birth (4.1%-6.0%) than studies of second and third trimester patients (fetal loss 0.6%; preterm birth 12.5%). Conclusions Absolute risks of adverse fetal outcomes after non-obstetric abdominopelvic surgery vary based on the indication and trimester of pregnancy. Estimates derived in this study can be used to counsel pregnant patients preoperatively.