Antibiotic is a safe and feasible option for uncomplicated appendicitis in pregnancy ‐ A retrospective cohort study

Abstract

Introduction Acute appendicitis is the commonest surgical emergency during pregnancy. The aim of this study is to evaluate the outcomes between antibiotic therapy and appendectomy in the management of uncomplicated appendicitis during gestation. Methods From January 2015 to April 2019, there were 2174 emergency appendicitis diagnosed in the University of Hong Kong‐Shenzhen Hospital. Among them, 54 pregnant women were diagnosed with acute uncomplicated appendicitis and the clinical records were reviewed. Clinical demographics and outcomes including gestational age at delivery, mode of delivery, birth weight, APGAR score at 1 minute, fetal loss and overall length of stay were compared between the operation group and the antibiotic treatment group. Results The baseline characteristics showed no statistically significant difference between the two groups (P > .05). In the appendectomy group (n = 20), one patient had wound infection while none of the patients in the antibiotic therapy group (n = 34) experienced any complication. In the antibiotic treatment group, appendicitis recurred in one patient during pregnancy and in two patients after deliveries, which were all treated with appendectomy. The mean hospital stay of the antibiotic treatment group was shorter than that of the appendectomy group, but there was no significant difference (4.94 ± 2.6 days vs 6.25 ± 3.5 days, P = .540). There was no difference in gestational age at delivery, mode of delivery, birth weight and APGAR scores between the two groups (P > .05). Conclusions For acute uncomplicated appendicitis during pregnancy, antibiotics treatment is a safe and feasible option.

Association of treatments for acute appendicitis with pregnancy outcomes in the United States from 2000 to 2016: Results from a multi-level analysis

“…Our study showed that NST was associated with lower risk of preterm labor by 60% as compared with OA, but no difference in abortion and cesarean section between NST and OA treatments was seen. Although some previous studies suggested that conservative treatment of AA in pregnant women achieved satisfactory pregnancy outcomes, these patients normally had relatively mild conditions [ 4 ]. The World Society of Emergency Surgery guidelines note that no evidence supports superior performance of conservative treatment in pregnancy outcomes, as compared with surgical treatments [ 5 ].…”

“…Previous studies have assessed the association of laparoscopy with adverse pregnancy outcomes, particularly with fetal loss, preterm birth, and cesarean section. While a significantly lower risk of preterm birth was found in patients treated by LA than OA [ 22 ], other studies found no difference in preterm birth between the two surgical approaches [ 2 , 3 , 4 ], and few studies found that LA was associated with increased risk of fetal loss [ 6 , 22 – 24 ]. A case–control study reported that LA during pregnancy was associated with an increased rate of cesarean delivery [ 12 ], while other studies found that the risk of cesarean delivery for LA and OA treatments was comparable [ 6 , 25 ].…”

“…If the pathological condition of AA is not severe, or the patient’s physical condition is temporarily unsuitable for surgical treatment, NST, a conservative treatment method (e.g., with antibacterial and/or anti-inflammatory drugs) is often chosen. In Korea, approximately 25% of pregnancies affected by uncomplicated AA are treated conservatively [ 3 ], compared to 63% in China [ 4 ]. In contrast, for complicated AA in pregnancy, OA and LA are the two most frequent choices.…”

Analysis of 190 Female Patients after Appendectomy

“…A study from China to see the association between antibiotics and complication rate among 54 pregnant women showed that the patients with antibiotics ( n = 34) experienced no complications. However, recurrence occurred in the conservative group in one patient during pregnancy and two patients after delivery, treated with appendectomy [ 35 ]. In our data, complicated appendicitis was 25% in pregnant vs. 9% in nonpregnant women.…”

“…Prolonged exposure to anesthesia can have an adverse effect. The mean operating time of LA is 45 minutes (range: 10–70 minutes) [ 17 , 18 , 27 , 32 , 35 , 36 ]. In our data, the average time did not differ in the two groups, with a mean of 50 minutes.…”