Prevention of pregnancy loss after appendectomy

Abstract

Aim. To optimize preventive measures for miscarriage after appendectomy based on a study of the gestation course pathogenetic features in acute appendicitis. Methods. 78 pregnant women who had underwent surgery for acute appendicitis during gestation (gestation term from 4 to 30 weeks) were examined. The control group consisted of healthy 37 women with normal gestation. Serum prolactin level was measured by ELISA. Leukocyte intoxication index, combined endotoxin titre, coagulation tests (fibrinogen, soluble fibrin monomers, activated partial thromboplastin time, fibrinolysis time) were also examined. serum cytokine levels (interleukine-1β, -2, -4, -6, interferon γ, tumor necrosis factor α) were measured by solid-phase enzyme immunoassay. Patients of comparison group (n=42) received standard treatment targeted on pregnancy prolongation after the surgery. Discrete plasmapheresis was added to treatment offered for patients of the main group (n=36) at 3rd and 5th days after the appendectomy. Results. Endogenous intoxication syndrome development in association with hyper coagulation and simultaneous fibrinolysis inhibition and increase of paracoagulation products levels combined with pro-inflammatory cytokines level increase was noted in pregnant patients with appendicitis. Prolactin level increased by 1.5-1.8 times at 5-7 days after surgery with further decrease at 10-14 day accompanied by risk of miscarriage. The use of discrete plasmapheresis at 3rd and 5th days after surgery contributes to maintaining stable concentrations of prolactin in pregnant women in all terms during the postoperative period, as well as endogenous intoxication indicators decrease, hemostasis and cytokine profile normalization, allowing to increase the rate of successful pregnancy outcomes after appendectomy. Conclusion. Addition of plasmapheresis as a component of complex treatment in pregnant women after appendectomy allowed to reduce the risk of miscarriage by 4 times, and the rate of miscarriage by twice, suggesting this method as a safe and effective way to prevent miscarriage.