Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes

Abstract

BACKGROUND:During pregnancy, the most common indication for non-obstetric surgery in acute abdomen is appendicitis. In pregnancy, appendicitis may be confused with pregnancy-related pathologies and may cause a delay in diagnosis or unnecessary surgery. The present study aims to evaluate the maternal and neonatal outcomes of patients undergoing appendectomy during pregnancy. METHODS:This study was designed retrospectively between 2011-2017. Appendicitis detection rates, admission and laboratory features, operation results and obstetric results were evaluated in pregnant women who underwent surgery for a preliminary diagnosis of acute appendicitis. RESULTS:The findings showed that 2593 patients underwent an appendectomy, 1154 of them were women and 50 of them were pregnant. Negative laparotomy was detected in 12 (16%) patients. Six (12%) of these 50 patients had a laparoscopic appendectomy and 44 (88%) had an appendectomy with laparotomy. The mean time to operation after admission to hospital was 10.5±11 hours. No maternal mortality was observed. Preterm labor occurred in four (8%) patients. Two patients (4%) were in the second trimester and two patients (4%) were in the third trimester. Two (4%) newborns born in the second trimester died postpartum. One of these newborns had multiple anomalies. Appendectomy was not characterized by an increased risk of perinatal mortality. CONCLUSION: Delay in the diagnosis and surgery of acute appendicitis during pregnancy may increase the risk of perinatal mortality and should not be delayed in diagnosis and surgery in pregnancy.

Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review

“…Fourteen studies reported population-based data, 10–12,15,22,23,26,29,31,33,35,42,45,50 three studies reported multicenter data 36,39,60 and 43 studies reported single-center data, 13,14,16–21,24,25,27,28,30,32,34,37,38,40,41,43,44,46–49,51–59,61–69 and all, expect one small prospective single-center study on 22 women,63 were retrospective.…”

“…Data on developmental delays were reported in three studies, 49,57,63 and data on congenital anomalies were reported in eight studies. 11,14,17,18,32,50,51,58 There were no cases of developmental delays. Non-obstetric surgery (n = 5453) did not affect the prevalence of congenital anomalies, the prevalence was 4.1% in both groups.…”

“…We were also interested in studies comparing laparoscopic and open surgeries in abdominal cavity surgeries, and data were available from 32 studies for 36,120 pregnant women. 10,17,21,22,[24][25][26]28,[30][31][32][34][35][36][37][38][39]41,45,46,48,49,[52][53][54][55]57,58,63,65,68,69 In these studies, the use of these two approaches was similar; 47% of patients had laparoscopic and 53% open surgery. However, there was wide distribution between the studies, the lowest proportion of laparoscopic approach 5% 22 and the highest 89%.…”

“…Appendectomy is one of the most common surgeries during pregnancy, and 31 studies evaluated pregnancy outcomes in women who underwent this procedure. 10, 13, 17, 18 22, 26, 28, 31,32,36-39, 41, 45, 46,48-55, 57, 62–66, 68, 69…”

“…Data regarding the trimester when surgery was performed were available in the majority of the studies. 11–14,16,17,19,21–25,28–30,32,35–39,41,42,47–51,53,54,56,59–63,66,68,69 There were data for 47,153 pregnant women; 43% of procedures were carried out during the first, 32% during the second, and 25% during the third trimester.…”