Is Pregnancy Following a TRAM or DIEP Flap Safe? A Critical Systematic Review and Meta-analysis.

BACKGROUND Previous data were not conclusive on the safety of gestation in patients whose abdominal flaps were earlier harvested. We performed a meta-analysis to evaluate the abdominal wall complications and birth mode of pregnancy in post-TRAM or post-DIEP harvested individuals. METHODS A literature search was performed using the PubMed, Embase, Scopus, and Google scholar database. Heterogeneity was statistically analyzed, and random effect models were applied. Publication bias was assessed by funnel plot. RESULTS We included 25 papers that captured 56 patients giving birth to 69 healthy babies after elevation of abdominally based flaps, with a pooled abdominal complication rate of 0.00-0.09. The complication incidence in TRAM group was 0.01 (95% CI = [0.00-0.14%]) while 0.00 in the DIEP group (95% CI = [0.00-0.26%]). Discrepancies in incidence following unilaterally or bilaterally based TRAM flaps, following free or pedicled TRAM flaps, following primary sutured or mesh strengthened fascia, following MS free TRAM or conventional free TRAM could not be calculated as statistically significant. TRAM group and DIEP group patients had identical birth modes. CONCLUSIONS The present meta-analysis did not detect evidence that abdominal walls with the prior harvest of abdominal flaps could affect the process of pregnancy or contraindicate vaginal delivery. No abdominal hernia or bulge occurred with post-DIEP pregnancies. However, such conclusions need to be substantiated by larger sample studies. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .