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BJOG. 2014 Nov;121(12):1509-14. doi: 10.1111/1471-0528.12736. Epub 2014 Mar 28.

Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases.

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  • 1Department of Obstetrics and Gynaecology, Jewish General Hospital, Montreal, QC, Canada.

Abstract

OBJECTIVE:

To compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis.

DESIGN:

Population-based matched cohort study.

SETTING:

United States of America.

SAMPLE:

A total of 7114 women with appendicitis among 7,037,386 births.

METHODS:

Logistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest.

MAIN OUTCOME MEASURES:

Maternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis.

RESULTS:

There was an overall incidence of 101.1 cases of appendicitis per 100,000 births. Appendicitis was diagnosed in 35,570 nonpregnant women during the corresponding time frame. Peritonitis occurred in 20.3% of pregnant women with appendicitis, with an adjusted OR of 1.3 (95% CI 1.2-1.4) when compared with nonpregnant women with appendicitis. In pregnancy, there was an almost two-fold increase in sepsis and septic shock, transfusion, pneumonia, bowel obstruction, postoperative infection and length of stay >3 days. Whereas 5.8% of appendicitis cases among pregnant women were managed conservatively, they were associated with a considerably increased risk of shock, peritonitis and venous thromboembolism as compared to surgically managed cases.

CONCLUSIONS:

Compared with nonpregnant women, pregnant women with acute appendicitis have higher rates of adverse outcomes. Conservative management should be avoided given the serious risk of adverse outcomes in pregnancy.

© 2014 Royal College of Obstetricians and Gynaecologists.

KEYWORDS:

Appendicitis; maternal outcomes; peritonitis; postoperative complications; pregnancy

PMID:
24674238
[PubMed - indexed for MEDLINE]
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