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

ObjectiveTo compare outcomes and management practices among pregnant and nonpregnant women with acute appendicitis. DesignPopulation-based matched cohort study. SettingUnited States of America. SampleA total of 7114 women with appendicitis among 7037386 births. MethodsLogistic regression analyses to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables and outcomes of interest. Main outcome measuresMaternal morbidities associated with appendicitis; management practices for pregnant and age-matched nonpregnant women with appendicitis. ResultsThere was an overall incidence of 101.1 cases of appendicitis per 100000 births. Appendicitis was diagnosed in 35570 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 >3days. 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. ConclusionsCompared 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.