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.Keywords Appendicitis, maternal outcomes, peritonitis, postoperative complications, pregnancy.Please cite this paper as: Abbasi N, Patenaude V, Abenhaim HA. Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases . BJOG 2014;121:1509-1514

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VTE is a rare but serious condition that is increasing in incidence and is associated with a significant degree of maternal morbidity and mortality. Further research targeting prevention among high-risk groups is warranted.

Although rare, appendicitis in pregnancy is associated with adverse maternal outcomes and worsened in cases of peritonitis. Measures to decrease risk of peritonitis should be taken in order to limit associated morbidities.

Objective To compare perinatal outcomes associated with three methods of selective reduction in complicated monochorionic (MC) twin pregnancies: bipolar cord coagulation (BC), fetoscopic or ultrasound guided laser cord occlusion and radiofrequency ablation (RFA). Methods Retrospective cohort study of complicated MC twin pregnancies undergoing selective fetal reduction at a tertiary fetal center over a 20‐year period. Obstetric and perinatal outcomes were compared. Results 105 procedures met inclusion criteria: 74 RFAs, 17 lasers and 14 BCs. Procedure duration was significantly shorter for RFA (27.4 ± 15.8 minutes) compared to BC (91.7 ± 38.7 minutes) and laser (83.4 ± 40.4 minutes), P < .0001). The incidence of preterm prelabor rupture of membranes (PPROM) and co‐twin demise did not differ between groups, however preterm delivery <34 weeks occurred less frequently following RFA (29.7%), compared to laser (64.7%) or BC (42.9%) (P = .02); delivery <37 weeks was also less frequent following RFA (45.9%), compared to laser (76.5%) or BC (78.6%)(P = .01). The difference in preterm birth<34 weeks between RFA and laser was maintained after adjusting for cord occlusion indication and amnionicity (OR 3.96, 95% CI 1.27‐12.31). Conclusions In our experience, RFA procedures were simpler, faster and associated with a lower risk of preterm delivery <34 and <37 weeks, compared to laser or BC.